PMC6358339_01
A chest X-ray of Case 1 shows herniating loops of the bowel and a mediastinal shift to the right side resulting from the left-sided congenital diaphragmatic hernia.
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F1
He subsequently underwent chest X-ray because of respiratory distress, and left-sided diaphragmatic hernia was diagnosed (Fig. 1).
Photomicrographs of Case 1. A: A hernia sac resected at the initial patch repair surgery contained hepatocytes and bile ducts without atypia accompanied by vascular congestion (hematoxylin and eosin stain; the bar indicates 50 mum). B: A hernia sac resected at the second patch repair surgery for the recurrent congenital diaphragmatic hernia contained clusters of hepatocytes and bile ducts accompanied by vascular congestion (hematoxylin and eosin stain; the bar indicates 20 mum). C: Hepatocytes in the hernia sac were positive for hepatocyte-specific antigen (immunohistochemistry; the bar indicates 20 mum). D: Bile ducts were positive for cytokeratin 19 (immunohistochemistry; the bar indicates 20 mum).
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F2
They consisted of thin fibrous connective tissue covered by mesothelium and accompanied by vascular congestion, in which clusters of hepatocytes and bile ducts were observed (Fig. 2A and B). Immunohistochemically, the hepatocytes were positive for hepatocyte-specific antigen (OCH1E5), and the bile ducts were positive for cytokeratin 19 (Fig. 2C and D).
Photomicrographs of Case 2. A: A low-power view of isolated ectopic accessory liver lobe beneath the hernia sac (hematoxylin and eosin stain; the bar indicates 200 mum). B: A high-power view of the isolated ectopic accessory liver lobe beneath the hernia sac shows hepatocytes and bile ducts accompanied by vascular congestion (hematoxylin and eosin stain; the bar indicates 20 mum). C: A low-power view of an epidermal cyst in the hernia sac (hematoxylin and eosin stain; the bar indicates 200 mum). D: A high-power view of an epidermal cyst in the hernia sac shows a stratified squamous epithelium without atypia.
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F3
An isolated nodule attached to the border of the defect foramen was 10 x 4 x 3 mm in size and consisted of clusters of hepatocytes and bile ducts accompanied by vascular congestion (Fig. 3A and B). A hernia sac, measuring 55 x 40 x 15 mm in size, contained fibrous tissue covered by mesothelium, in which an epidermal cyst was observed (Fig. 3B and D).