151
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Imaging of Rare Primary Malignant Hepatic Tumors in Adults With Histopathological Correlation. J Comput Assist Tomogr 2017; 40:452-62. [PMID: 26938690 DOI: 10.1097/rct.0000000000000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma and cholangiocarcinoma are the most common primary liver malignancies in adults (comprising >85%); however, liver is also host to some unusual primary malignant tumors. Some of these tumors show distinct demographic, clinicopathologic, and imaging features. Imaging features of these uncommon primary malignant liver tumors are presented with an attempt to correlate them with histopathology.
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152
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Ono M, Kasuga Y, Uehara T, Oda Y. Epithelioid hemangioendothelioma of the thyroid: a case report. Surg Case Rep 2017; 3:18. [PMID: 28132160 PMCID: PMC5274636 DOI: 10.1186/s40792-017-0294-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/24/2017] [Indexed: 01/08/2023] Open
Abstract
Background Epithelioid hemangioendothelioma (EHE) of the thyroid is an extremely rare disease; only three cases have been reported in the English literature to date. Here, we describe a case involving a patient with thyroid EHE successfully treated with curative surgery. Case presentation A 74-year-old woman presented with a right thyroid mass. The nodule was approximately 2 cm in size and was diagnosed as an indeterminate lesion by fine needle aspiration cytology. She was treated with thyroid lobectomy. The histopathological and immunohistochemical findings indicated an EHE of the thyroid. At the latest follow-up, 3 years postoperatively, the patient showed no signs of recurrence. Conclusion There is currently no standard therapy for EHE; however, our case suggests that curative resection represents an effective treatment.
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Affiliation(s)
- Mayu Ono
- Department of Breast and Endocrine Surgery, Nagano Matsushiro General Hospital, 183 Matsushiro, Nagano, 381-1231, Japan. .,Present address: Department of Breast and Endocrine Surgery, Iida Municipal Hospital, 438 Yawatamachi, Iida, 812-8582, Japan.
| | - Yoshio Kasuga
- Department of Breast and Endocrine Surgery, Nagano Matsushiro General Hospital, 183 Matsushiro, Nagano, 381-1231, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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153
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Morishita A, Iwama H, Yoneyama H, Sakamoto T, Fujita K, Nomura T, Tani J, Miyoshi H, Fujihara S, Nishiyama N, Kobara H, Mori H, Yamamoto N, Okano K, Suzuki Y, Ibuki E, Haba R, Himoto T, Masaki T. MicroRNA profile of hepatic epithelioid hemangioendothelioma: A case report. Oncol Lett 2017; 13:1655-1659. [PMID: 28454305 PMCID: PMC5403268 DOI: 10.3892/ol.2017.5643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/01/2016] [Indexed: 01/03/2023] Open
Abstract
A 72-year-old female was referred for further evaluation of epigastralgia. Abdominal contrast computed tomography revealed numerous tumors in the two lobes of the liver. Liver biopsy and immunohistochemical staining revealed that the tumor cells were positive for factor VIII-associated antigen, platelet endothelial cell adhesion molecule 1 and human hematopoietic progenitor cell antigen, concordant with a diagnosis of hepatic epithelioid hemangioendothelioma (HEH). To elucidate the etiology of HEH, particularly the microRNA (miRNA) profiles, tissue samples obtained from normal and tumor tissues were analyzed using a miRNA array system. A total of 14 miRNAs were significantly upregulated and 93 miRNAs were downregulated in the tumor tissues (P<0.01). Additionally, unsupervised hierarchical clustering analysis using Pearson's correlation revealed that the tumor tissues clustered separately from the normal tissues. The miRNA expression profile was analyzed in HEH and compared with angiosarcoma, which exhibits histology similar to HEH. Out of a total of 107 miRNAs, only miR-122-5p and miR-1290 demonstrated a differential expression pattern in angiosarcoma. Therefore, these miRNAs may be novel biological markers for the determination of a diagnosis of HEH in primary mesenchymal tumors of the liver. To the best of our knowledge, this study is the first report of a miRNA microarray analysis in HEH.
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Affiliation(s)
- Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Hisakazu Iwama
- Life Science Research Center, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Hirohito Yoneyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Teppei Sakamoto
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Koji Fujita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Takako Nomura
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Joji Tani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Hisaaki Miyoshi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Hirohito Mori
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Naoki Yamamoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Emi Ibuki
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
| | - Takashi Himoto
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Takamatsu, Kagawa 761-0123, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa 761-0793, Japan
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154
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Yang JW, Li Y, Xie K, Dong W, Cao XT, Xiao WD. Spontaneous rupture of hepatic epithelioid hemangioendothelioma: A case report. World J Gastroenterol 2017; 23:185-190. [PMID: 28104995 PMCID: PMC5221283 DOI: 10.3748/wjg.v23.i1.185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/27/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular endothelial origin. Spontaneous rupture of HEH is a life-threatening complication and is extremely rare. HEH has variable malignant potential, and the clinical diagnosis remains challenging. Here we report a case of HEH with spontaneous rupture. A 44-year-old man presented with constant cutting pains over the right upper abdomen after eating. He had hemoptysis 11 d previously. Diagnostic abdominal puncture demonstrated active bleeding. Chest and abdominal computer tomography scan showed multiple ground-glass nodules over the lungs, multiple low-density intrahepatic nodules and massive hemorrhage. Transcatheter arterial embolization and exploratory laparotomy were performed and subsequent immunohistochemical examination confirmed a diagnosis of HEH.
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155
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Afrit M, Nasri M, Labidi S, Mejri N, El Benna H, Boussen H. Aggressive primary hepatic epithelioid hemangioendothelioma: a case report and literature review. Cancer Biol Med 2017; 14:187-190. [PMID: 28607810 PMCID: PMC5444931 DOI: 10.20892/j.issn.2095-3941.2016.0105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A new case of epithelioid hemangioendothelioma is reported to have occurred to a 67-year-old patient who consulted for right-sided chest pain. The work-up showed multiple right pulmonary lesions associated with bilateral moderate pleural effusion and left-sided pleural thickening and three hypodense nodules in the right lobe of the liver, peritoneal thickening, ascites, and multiple vertebral lytic lesions. The diagnosis of an epithelioid hemangioendothelioma was concluded through a histological examination of a computed tomography scan guided biopsy of the liver. The patient received a primary mono-chemotherapy with Adriamycin (75 mg/m2 every three weeks) and intravenous bisphosphonates without response and general status impairment. The patient died after 16 months of follow-up.
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Affiliation(s)
- Mehdi Afrit
- Medical Oncology Department, Abderahman Mami Hospital, Ariana 2080, Tunisia
| | - Meher Nasri
- Medical Oncology Department, Abderahman Mami Hospital, Ariana 2080, Tunisia
| | - Soumaya Labidi
- Medical Oncology Department, Abderahman Mami Hospital, Ariana 2080, Tunisia
| | - Nesrine Mejri
- Medical Oncology Department, Abderahman Mami Hospital, Ariana 2080, Tunisia
| | - Houda El Benna
- Medical Oncology Department, Abderahman Mami Hospital, Ariana 2080, Tunisia
| | - Hamouda Boussen
- Medical Oncology Department, Abderahman Mami Hospital, Ariana 2080, Tunisia
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156
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Shamim SA, Tripathy S, Mukherjee A, Bal C, Roy SG. 18-F-FDG PET-CT in Monitoring of Chemotherapeutic Effect in a Case of Metastatic Hepatic Epithelioid Hemangioendothelioma. Indian J Nucl Med 2017; 32:237-238. [PMID: 28680215 PMCID: PMC5482027 DOI: 10.4103/ijnm.ijnm_171_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatic epithelioid hemangioendothelioma is a rare variant of mesenchymal tumor. Surgical resection or partial hepatectomy is the treatment of choice in the case of localized disease. However, in metastatic cases, chemotherapeutic drugs targeting the tyrosine kinase are being used. We hereby present 18-F-fludeoxyglucose positron emission tomography-computed tomography findings in a case of a 35-year old woman with metastatic HEHE showing significant response to Sorafenib therapy after 6 months.
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Affiliation(s)
- Shamim Ahmed Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarthak Tripathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anirban Mukherjee
- Department of Nuclear Medicine, Eastern Diagnostics, Kolkata, West Bengal, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shambo Guha Roy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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157
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Wang Q, Huang HF, Li ZT, Zhao XR, Duan J, Lin J, Xia ZC, Zeng Z. Diagnosis and treatment of hepatic perivascular epithelioid cell tumor: A case report and literature review. Shijie Huaren Xiaohua Zazhi 2016; 24:4315-4318. [DOI: 10.11569/wcjd.v24.i31.4315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver perivascular epithelioid cell tumor is a rare liver mesenchymal tumor with an insidious onset. This entity is often misdiagnosed due to the lack of typical clinical symptoms and signs and the low diagnosis rate achieved by imaging examinations. Here we report a case of liver perivascular epithelioid cell tumor. We also performed a literature review to summarize and analyze the clinical characteristics and treatment of this disease.
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158
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Giardino A, Miller FH, Kalb B, Ramalho M, Martin DR, Rodacki K, Woosley JT, Semelka RC. Hepatic epithelioid hemangioendothelioma: a report from three university centers. Radiol Bras 2016; 49:288-294. [PMID: 27818541 PMCID: PMC5094816 DOI: 10.1590/0100-3984.2015.0059] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective To determine common imaging findings of hepatic epithelioid
hemangioendothelioma on magnetic resonance images. Materials and Methods A search was made of three institutional databases between January 2000 and
August 2012. Seven patients (mean age, 47 years; range, 21-66 years; 6
women) with pathology-confirmed diagnosis of hepatic epithelioid
hemangioendothelioma who had undergone magnetic resonance imaging were
identified. None of the patients had received any treatment for hepatic
epithelioid hemangioendothelioma at the time of the initial magnetic
resonance imaging examination. Results Hepatic epithelioid hemangioendothelioma tumors appeared as focal masses in
7/7 patients, greater than 5 in number, with a coalescing lesion in 1/5, and
peripheral localization in 6/7. Capsular retraction was present in 4/7, and
was associated with peripherally located lesions. Early ring enhancement was
appreciated in the majority of lesions in 7/7 patients. Centripetal
progressive enhancement was shown in 5/7 patients on venous phase that
exhibited a distinctive thick inner border of low signal on venous phase
images, and a central core of delayed enhancement. Small lesions did not
show this. Conclusion The combination of multifocal round-configuration lesions that are
predominantly peripheral and exhibit early peripheral ring enhancement and
late appearance of an inner thick border of low signal and central core of
high signal may represent an important feature for hepatic epithelioid
hemangioendothelioma.
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Affiliation(s)
- Antonello Giardino
- MD, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Universitá degli Studi di Milano, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Frank H Miller
- MD, FACR, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bobby Kalb
- MD, Department of Radiology, University of Arizona Medical Center, Tucson, Arizona, USA; Department of Radiology, The Emory Clinic, Wesley Woods Geriatric Hospital, Atlanta, GA, USA
| | - Miguel Ramalho
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | - Diego R Martin
- MD, PhD, Department of Radiology, University of Arizona Medical Center, Tucson, Arizona, USA; Department of Radiology, The Emory Clinic, Wesley Woods Geriatric Hospital, Atlanta, GA, USA
| | - Karina Rodacki
- MD, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Ecomax - Centro de Diagnóstico por Imagem, Blumenau, SC, Brazil
| | - John T Woosley
- MD, PhD, Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard C Semelka
- MD, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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159
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Wu CH, Chiu NC, Yeh YC, Kuo Y, Yu SS, Weng CY, Liu CA, Chou YH, Chiou YY. Uncommon liver tumors: Case report and literature review. Medicine (Baltimore) 2016; 95:e4952. [PMID: 27684838 PMCID: PMC5265931 DOI: 10.1097/md.0000000000004952] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Beside hepatocellular carcinoma, metastasis, and cholangiocarcinoma, the imaging findings of other relatively uncommon hepatic lesions are less discussed in the literature. Imaging diagnosis of these lesions is a daily challenge. In this article, we review the imaging characteristics of these neoplasms. METHODS From January 2003 to December 2014, 4746 patients underwent liver biopsy or hepatic surgical resection in our hospital. We reviewed the pathological database retrospectively. Imaging of these lesions was reviewed. RESULTS Imaging findings of uncommon hepatic lesions vary. We discuss the typical imaging characteristics with literature review. Clinical and pathological correlations are also described. Primary hepatic lymphoma consists only of 1% of the extranodal non-Hodgkin lymphoma, and is defined as the one involving only the liver and perihepatic lymph nodes within 6 months after diagnosis. Combined hepatocellular and cholangiocarcinoma (cHCC-CC) shares some overlapping imaging characteristics with both HCC and cholangiocarcinoma because of being an admixture of them. Angiosarcoma is the most common hepatic mesenchymal tumor and is hypervascular in nature. Inflammatory pseudotumor is often heterogeneous on ultrasonography and with enhanced septations and rims in the portovenous phase after contrast medium. Angiomyolipoma (AML) typically presents with macroscopic fat components with low signal on fat-saturated magnetic resonance imaging (MRI) and presence of drainage vessels. Intraductal papillary neoplasm of the bile duct (IPNB) is thought of as a counterpart to the pancreatic intraductal papillary mucinous neoplasm. Most of the IPNBs secrete mucin and cause disproportional dilatation of the bile ducts. Mucinous cystic neoplasm (MCN) contains proteinaceous and colloidal components without ductal communication and characterizes with hyperintensity on T1-weighted imaging. Other extremely rare lesions, including epithelioid hemangioendothelioma and inflammatory pseudotumor-like follicular dendritic cell sarcoma, are also discussed. Hepatoblastoma and mesenchymal hamartoma, mostly in children, are also briefly reviewed as well. CONCLUSION It is important for radiologists to be familiar with the typical imaging features of the uncommon hepatic neoplasms. If imaging findings are not typical or diagnostic, further biopsy is required.
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Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Nai-Chi Chiu
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Yi-Chen Yeh
- School of Medicine, National Yang-Ming University
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu Kuo
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Sz-Shian Yu
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Ching-Yao Weng
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Yi-You Chiou
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
- Correspondence: Yi-You Chiou, Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Beitou District, Taipei, 11217, Taiwan (e-mail: )
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160
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Aasen T, Patel A, Patel NM. A Rare Hepatic Tumor Mimicking Hepatocellular Carcinoma in a Patient With Hepatitis C Cirrhosis. Clin Gastroenterol Hepatol 2016; 14:A29-30. [PMID: 27211497 DOI: 10.1016/j.cgh.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Tyler Aasen
- Banner University Medical Center-Phoenix, Phoenix, Arizona
| | | | - Nayan M Patel
- Banner University Medical Center-Phoenix, Phoenix, Arizona; Banner Transplant Center and Advanced Liver Disease, Phoenix, Arizona
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161
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Abstract
INTRODUCTION Epithelioid hemangioedothelioma (EHE) is a rare vascular tumor characterized by neoplastic proliferation of epithelioid or histiocytoid epithelial cells. EHE of bone constitutes <1% of primary malignant bone tumor. EHE in the skull is an extremely rare case. Here, we report a case of multiple neoplasm of the skull in a 15-month-old boy who presented with gradual facial swelling for 2 months. On computed tomography (CT) scan, multiple irregular osteolytic lesions were seen on the right maxillary, sphenoid, left zygoma, and roof of the left orbit. Excisional surgery of the lesion was planned. Histopathological and immunohistochemical examination of excised specimen suggest it to be epithelioid hemangioedothelioma. Follow-up for 6 months showed no recurrence. CONCLUSION Epithelioid hemangioedothelioma is a locally aggressive tumor with metastatic potential. CT imaging could help in assessment of lesion, but final diagnosis is possible only with histopathology. Complete surgical resection at the early stage of the disease is the most effective treatment with better prognosis.
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Affiliation(s)
| | - Miao Fan
- Department of Radiology
- Correspondence: Miao Fan, Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. 510080 (e-mail: )
| | | | - Wei Liang
- Department of Medical Records Management, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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162
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Yarze N, Yarze JC. Radiographic and Histologic Findings of a Rare Liver Tumor-Hepatic Epithelioid Hemangioendothelioma. Dig Dis Sci 2016; 61:1778-9. [PMID: 26809872 DOI: 10.1007/s10620-016-4039-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/10/2016] [Indexed: 12/09/2022]
Affiliation(s)
- Noel Yarze
- Ross University School of Medicine, Edison, NJ, USA
| | - Joseph C Yarze
- Gastroenterology Associates of Northern New York, Glens Falls, NY, USA. .,Clinical Associate Professor of Medicine, Albany Medical College, Albany, NY, USA.
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163
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Dong Y, Wang WP, Cantisani V, D’Onofrio M, Ignee A, Mulazzani L, Saftoiu A, Sparchez Z, Sporea I, Dietrich CF. Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma. World J Gastroenterol 2016; 22:4741-4749. [PMID: 27217705 PMCID: PMC4870080 DOI: 10.3748/wjg.v22.i19.4741] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma (HEHE) in comparison to other multilocular benign focal liver lesions (FLL).
METHODS: Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in consensus.
RESULTS: HEHE manifested as a single (n = 3) or multinodular (n = 22) FLL. On CEUS, HEHE showed rim-like (18/25, 72%) or heterogeneous hyperenhancement (7/25, 28%) in the arterial phase and hypoenhancement (25/25, 100%) in the portal venous and late phases (PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas (18/25, 72%); in seven patients (7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature (P < 0.01).
CONCLUSION: CEUS allows for characterization of unequivocal FLL. By analyzing the hypoenhancement in the PVLP, CEUS can determine the malignant nature of HEHE.
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164
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Liver transplantation for hepatobiliary malignancies: a new era of "Transplant Oncology" has begun. Surg Today 2016; 47:403-415. [PMID: 27130463 DOI: 10.1007/s00595-016-1337-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/06/2016] [Indexed: 01/10/2023]
Abstract
The indications of liver transplantation for hepatobiliary malignancies have been carefully expanded in a stepwise fashion, despite the fundamental limitations in oncological, immunological, and technical aspects. A new era of "Transplant Oncology," the fusion of transplant surgery and surgical oncology, has begun, and we stand at the dawn of a paradigm shift in multidisciplinary cancer treatment. For hepatocellular carcinoma, new strategies have been undertaken to select recipients based on biological and dynamic markers instead of conventional morphological and static parameters, opening the doors for a more deliberate expansion of the Milan criteria and locoregional therapies before liver transplantation. Neoadjuvant chemoradiation therapy followed by liver transplantation for unresectable perihilar cholangiocarcinoma developed by the Mayo Clinic provided excellent outcomes in a US multicenter study; however, the surgical indications are not necessarily universal and await international validation. Similarly, an aggressive multidisciplinary approach has been applied for other tumors, including intrahepatic cholangiocarcinoma, hepatoblastoma, liver metastases from colorectal and neuroendocrine primary and gastrointestinal stromal tumors as well as rare tumors, such as hepatic undifferentiated embryonal sarcoma and infantile choriocarcinoma. In conclusion, liver transplantation is an important option for hepatobiliary malignancies; however, prospective studies are urgently needed to ensure the appropriate patient selection, organ allocation and living donation policies, and administration of antineoplastic immunosuppression.
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165
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Samuk I, Tekin A, Tryphonopoulos P, Pinto IG, Garcia J, Weppler D, Levi DM, Nishida S, Selvaggi G, Ruiz P, Tzakis AG, Vianna R. Abdominal transplantation for unresectable tumors in children: the zooming out principle. Pediatr Surg Int 2016; 32:337-46. [PMID: 26711121 DOI: 10.1007/s00383-015-3852-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE To present our experience in abdominal transplantations to manage unresectable abdominal neoplasms in children and to describe the role of extensive surgeries in such cases. METHODS This is a retrospective study of 22 abdominal transplantations in 21 patients for abdominal tumors over 16 years. Transplantation techniques included liver transplant (LT), multivisceral transplant (MVTx), and intestinal autotransplant (IA). Follow-up intervals ranged from 0.3 to 168 months (median 20 months). RESULTS LT alone was performed in 15 patients for primary malignant (11) and benign (4) liver tumors. Pathological classification included HB hepatoblastoma (6), HCC hepatocellular cancer (3), hepatic epithelioid hemangioendothelioma HEH (1), angiosarcoma (1), benign vascular tumors (3), and adenoma (1). IA was performed in four patients for lesions involving the root of the mesentery; tumors of the head of pancreas (3) and mesenteric hemangioma (1). MVTx was performed in 2 patients for malignancies; pancreaticoblastoma (1), recurrent hepatoblastoma (1), and in one patient as a rescue procedure after IA failure. Four of the eleven patients who underwent LT for malignant liver tumor had metastatic disease at presentation. Six of them died of recurrent neoplasm (3), transplant-related complications (2), and underlying disease (1). All LT patients who had benign tumors are alive with functioning grafts. All IA patients survived and are on an oral diet, with one patient requiring TPN supplementation. One of the three patients who underwent MVTx died of metastatic disease. CONCLUSIONS Allo/auto transplantation for abdominal tumors is a valuable modality when conventional treatments fail or are not feasible.
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Affiliation(s)
- Inbal Samuk
- Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Sackler School of Medicine, Tel Aviv University, 14 kaplan Street, Petach-Tikvha, 49202, Israel. .,Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Akin Tekin
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ignacio G Pinto
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Universidad de Oviedo, Beca, Spain
| | | | - Debbie Weppler
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David M Levi
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seigo Nishida
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gennaro Selvaggi
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Phillip Ruiz
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Pathology, University of Miami, Miami, USA
| | - Andreas G Tzakis
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rodrigo Vianna
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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166
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Mehrabi A, Hoffmann K, Weiss KH, Mogler C, Schemmer P, Büchler MW, Alldinger I. Long term follow up after resection emphasizes the role of surgery in Primary Hepatic Epithelioid Hemangioendothelioma. Ann Med Surg (Lond) 2016; 11:1-4. [PMID: 27594996 PMCID: PMC4995439 DOI: 10.1016/j.amsu.2016.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 12/15/2022] Open
Abstract
Background Primary Hepatic Epithelioid Hemangioendothelioma is an extremely rare tumor of vascular origin. Patients In this work we present clinical data and long term results of eight patients who were surgically treated in our institution. Liver transplantation was performed in five patients (four cadaveric and one living related) and major liver resection in three patients. Three patients are alive with recurrent tumor. After a median follow-up of 100 months (48–266) all patients are alive. Conclusions Only surgery can provide cure in HEH. If the extent of the disease prohibits primary resection liver transplantation might offer the most valuable option. Primary Hepatic Epithelioid Hemangioendothelioma is an extremely rare tumor of vascular origin. In this work we present clinical data and long term results of eight patients who were surgically treated in our institution. Liver transplantation was performed in five patients (four cadaveric and one living related) and major liver resection in three patients. After a median follow up of 100 months (48–266) all eight patients are alive. During follow up, three patients developed recurrent tumor, one in the lung and the liver, one only in the liver, and one patient developed systemic metastases.
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Affiliation(s)
- Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Karl Heinz Weiss
- Department of Gastroenterology, University Hospital Heidelberg, Germany
| | - Carolin Mogler
- Institute of Pathology, University Hospital Heidelberg, Germany
| | - Peter Schemmer
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Markus W. Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
| | - Ingo Alldinger
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
- Corresponding author. Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, GermanyDepartment of GeneralVisceral and Transplantation SurgeryUniversity Hospital HeidelbergINF 110Heidelberg69120Germany
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167
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Kobayashi N, Shimamura T, Tokuhisa M, Goto A, Ichikawa Y. Sorafenib Monotherapy in a Patient with Unresectable Hepatic Epithelioid Hemangioendothelioma. Case Rep Oncol 2016; 9:134-7. [PMID: 27293400 PMCID: PMC4899657 DOI: 10.1159/000443986] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 49-year-old Japanese man had multiple huge masses (max. size 60 mm diameter) in his liver. These tumors were pathologically diagnosed by tumor biopsy as epithelioid hemangioendotheliomas of the liver. In this case, multiple liver tumors existed in both lobes. Also this patient did not agree to receive surgical resection including liver transplantation. Chemotherapy with sorafenib at a dose of 400 mg/body twice a day was started. About 6 months later, CT findings revealed that these tumors were shrinking slightly; 33 months later, the tumors obviously showed a partial response in accordance with the Response Evaluation Criteria in Solid Tumors (RECIST). Also 60 months later, the partial response continued with sorafenib monotherapy.
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Affiliation(s)
- Noritoshi Kobayashi
- Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Motohiko Tokuhisa
- Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ayumu Goto
- Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasushi Ichikawa
- Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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168
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Gan LU, Chang R, Jin H, Yang LI. Typical CT and MRI signs of hepatic epithelioid hemangioendothelioma. Oncol Lett 2016; 11:1699-1706. [PMID: 26998064 PMCID: PMC4774430 DOI: 10.3892/ol.2016.4149] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/12/2016] [Indexed: 02/06/2023] Open
Abstract
To investigate the typical magnetic resonance imaging (MRI) and computed tomography (CT) features of hepatic epithelioid hemangioendothelioma (HEH), the CT and MRI findings of 14 histopathologically confirmed cases of HEH were retrospectively analyzed. Non-contrast and dynamic contrast-enhanced scans were conducted in all cases. A total of 229 lesions were detected in the 14 cases. All cases were classified as one of three types: (i) Solitary nodular type (1 case, 7%); (ii) multifocal nodular type (11 cases, 79%); or (iii) diffuse type (2 cases, 14%). The diameter of the lesions ranged from 5 to 105 mm. For the first two types (solitary and multifocal nodular types), the CT findings included low density lesions with clear margins on non-contrast scans, centripetal enhancement in arterial phase, and homogeneous enhancement in the portal venous and delay phases. The findings of non-contrast MRI scans for these two types included low signal intensity on T1-weighted images, heterogeneous high signal intensity on T2-weighted images, and heterogeneous high signal intensity on diffusion-weighted images. The lesions were predominantly located in submarginal areas. On contrast-enhanced MRI, the findings for the first two types included peripheral ring-like enhancement with a central low signal intensity (‘black target-like’ sign) and a central enhanced core surrounded by a low signal intensity halo (‘white target-like’ sign). The findings for the third HEH type (diffuse type) on CT and MRI scans included low density or heterogeneous signal intensity lesions involving regions of part or the whole liver, coalescent lesions (‘strip-like’ sign), and gradual enhancement along central vessels (‘lollipop’ sign). Collectively, these findings indicate that the ‘white target-like’ sign, ‘black target-like’ sign, ‘lollipop’ sign and ‘strip-like’ sign, in addition to capsular contraction and submarginal location, on CT and MRI imaging may have implications for the diagnosis of HEH. Furthermore, a variety of MRI sequences may provide additional information for the differential diagnosis of HEH.
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Affiliation(s)
- L U Gan
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Ruiping Chang
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Hualan Jin
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - L I Yang
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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169
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Aggressive Recurrence of Primary Hepatic Epithelioid Haemangioendothelioma after Liver Transplantation. Can J Gastroenterol Hepatol 2016; 2016:6135297. [PMID: 27446853 PMCID: PMC4904699 DOI: 10.1155/2016/6135297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
HEHE is a rare neoplasm of vascular origin that occurs in the liver; UNOS reported a favorable outcome after liver transplantation in 110 patients with 1-year and 5-year survival of 80% and 64%. Case Report. A 40-year-old lady presented with a three-month history of right upper abdominal pain with nausea, vomiting, and significant loss of weight associated with scleral icterus and progressive abdominal distension. Examination revealed jaundice, hepatomegaly, and ascites. Serum bilirubin was 26.5 mg/dL and ALP was 552 CT. Abdomen and pelvis showed diffuse infiltrative neoplastic process of the liver with a mass effect and stretching of the hepatic and portal veins, in addition to bile duct dilatation. Viral hepatitis markers were negative and serum alpha fetoprotein was within reference range. Liver biopsy was consistent with HEHE, with positive endothelial markers (CD31, CD34, and factor VIII-related antigen). She underwent living related liver transplantation on June 2013 and was discharged after 20 days with normal liver enzymes. Four months later, she presented with diffuse disease recurrence. Liver biopsy confirmed disease recurrence; she received supportive treatment and unfortunately she died 2 weeks later. Conclusion. HEHE can have rapid and aggressive recurrence after liver transplantation.
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170
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Giuliani A, Amato B, Marsilia GM, Tafuri D, Ceriello A, Santaniello W, Sodano L, Rocca A. Our experience of liver Epithelioid Hemangioendothelioma: from a misdiagnosis to liver transplantation with long term follow-up. Open Med (Wars) 2015; 10:508-512. [PMID: 28352745 PMCID: PMC5368874 DOI: 10.1515/med-2015-0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/02/2015] [Indexed: 01/17/2023] Open
Abstract
Malignant Hepatic Epithelioid hemangioendothelioma (HEHE) is an uncommon vascular tumor of intermediate malignant potential. HEHE is a rare tumor and it is difficult to diagnose for surgeons, hepatologists, radiologists and pathologists. So, misdiagnosis with a delay of the treatment is not uncommon. We describe a case of a young woman with a diagnosis of HEHE made 6 years after the first evidence of liver mass with a very long term follow-up after surgical treatment. She had two diagnoses of Hepatocellurar carcinoma (HCC) and a diagnosis of Cholangiocarcinoma after three different fine needle biopsies. After clinical observation, a new laparoscopic core biopsy was performed. In a first time approach, considering clinical and radiological patterns, a diagnosis of Budd-Chiari Syndrome was finally made. For that the patient underwent an orthotopicliver transplantation (OLTx). The surgical sample histological analysis allowed a definitive diagnosis of HEHE. At last, at follow up 7 years after three OLTx the patient is still alive and in good health with no evidence of recurrence.
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Affiliation(s)
- Antonio Giuliani
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation,"A. Cardarelli" Hospital, Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | | | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Antonio Ceriello
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation,"A. Cardarelli" Hospital, Naples, Italy
| | - Walter Santaniello
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation,"A. Cardarelli" Hospital, Naples, Italy
| | - Loredana Sodano
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation,"A. Cardarelli" Hospital, Naples, Italy
| | - Aldo Rocca
- Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation, "A. Cardarelli" Hospital, Naples, Italy , Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
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171
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Kim EH, Rha SE, Lee YJ, Yoo IR, Jung ES, Byun JY. CT and MR imaging findings of hepatic epithelioid hemangioendotheliomas: emphasis on single nodular type. ACTA ACUST UNITED AC 2015; 40:500-9. [PMID: 25179888 DOI: 10.1007/s00261-014-0229-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate imaging findings of hepatic epithelioid hemangioendothelioma (HEH), with emphasis on solitary form at the initial presentation. MATERIALS AND METHODS Ten cases of pathologically confirmed HEH were retrospectively reviewed; seven patients had CT and MR images and three had only CT images. Two radiologists assessed the followings in consensus: lesion number, size, location, presence of capsular retraction and calcification, attenuation, signal intensity, and enhancement pattern. RESULTS Initially, HEHs manifested as a single mass (n = 5) or multiple masses (n = 5). One case demonstrated a solitary nodule at first, which subsequently transformed to multifocal nodules on serial follow-up. The maximal diameter of the lesions ranged from 1.8 to 10 cm (mean 4.2 cm). All cases showed predominant subcapsular location. Capsular retraction was seen in multinodular types, but not in solitary types. Two patients had intra-lesional calcifications. HEHs showed minimal enhancement (7/7 patients) on the hepatic arterial phase CT and rim-like enhancement (5/10 patients), minimal enhancement (2/10 patients), multilayered target enhancement (2/10 patients), and peripheral nodular enhancement (1/10 patients) on the portal venous phase CT. On MR images (n = 7), HEHs showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images. Dynamic contrast-enhanced MR images revealed progressive centripetal fill-in enhancement (7/7 patients). On Gd-EOB-DTPA-enhanced hepatobiliary phase images, HEH manifested as homogeneous hypointensity (3/5 patients) and target-shaped hypointensity (2/5 patients). CONCLUSION HEH can manifest as single nodular, multinodular, or diffuse type. Common imaging features of HEH are multiple subcapsular nodules with coalescence, capsular retraction, peripheral, and delayed enhancement. However, HEH can manifest as a solitary subcapsular mass with minimal or rim-like enhancement at early phase and progressive centripetal fill-in enhancement during dynamic phase imaging, representing early stage of HEH. A single nodular type can progress to multifocal nodular type during follow-up.
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Affiliation(s)
- Eu Hyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
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172
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Athanasopoulos PG, Hadjittofi C, Luong TV, O'Beirne J, Sharma D. Synchronous Hepatic Epithelioid Hemangioendothelioma and Hepatocellular Carcinoma: First Case Report in the Literature and Challenges. Medicine (Baltimore) 2015; 94:e1377. [PMID: 26313777 PMCID: PMC4602905 DOI: 10.1097/md.0000000000001377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We would like to report the first case in English literature, to the best of our knowledge, of a synchronous hepatic epithelioid hemangioendothelioma (HEHE) and hepatocellular carcinoma (HCC), as well as to address the current trends and challenges in the management of HEHE.An otherwise well 58-year-old man was referred to his local hepatology service with elevated serum γ-GT levels. Imaging revealed bilobar liver lesions consistent with HEHE, a discrete left lobe lesion suspected as HCC, and multiple pulmonary nodules. Biopsies confirmed HEHE with pulmonary metastases. After multidisciplinary team discussions, the patient was admitted under our team and underwent an uneventful laparoscopic left lateral hepatectomy for suspected HCC, which was confirmed histologically.As part of a watch-and-wait approach to metastatic HEHE, in the first follow-up (3 months postoperatively) the patient was clinically fine and the surveillance CT scan did not show recurrent disease.By presenting this case, we aim to raise awareness that this rare entity can coexist with others, potentially complicating their management.
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Affiliation(s)
- Panagiotis G Athanasopoulos
- From the Division of Transplantation and Immunology, Royal Free London Hospital NHS Foundation Trust, University College London, London, United Kingdom (PGA, CH); Department of Cellular Pathology, Royal Free Hospital, London, United Kingdom (TVL); and Liver Transplant, Hepatology, Gastroenterology and HPB Surgery, Division of Transplantation and Immunology, Royal Free Hospital, London, United Kingdom (JOB, DS)
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173
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Kang SP, Xie FL, Zheng ZY. Hepatic epithelioid haemangioendothelioma: Report of one case. Shijie Huaren Xiaohua Zazhi 2015; 23:3166-3170. [DOI: 10.11569/wcjd.v23.i19.3166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with malignant biological behavior, which is frequently missed or misdiagnosed. Its diagnosis relies mainly on histological and immunohistochemical studies. Surgical resection is the main treatment. Here we report a case of hepatic EHE and performed a review of the relevant literature.
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174
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Lau A, Malangone S, Green M, Badari A, Clarke K, Elquza E. Combination capecitabine and bevacizumab in the treatment of metastatic hepatic epithelioid hemangioendothelioma. Ther Adv Med Oncol 2015; 7:229-36. [PMID: 26136854 DOI: 10.1177/1758834015582206] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare, often misdiagnosed vascular neoplasm with clinical behaviors that range from indolent to highly aggressive. Even when the appropriate diagnosis is achieved, the best treatment for HEHE has not been defined or standardized, further complicating the care of these patients. We present a diagnostically challenging case of HEHE where we utilized capecitabine and bevacizumab as another novel treatment option.
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Affiliation(s)
- Augustine Lau
- Yuma Regional Medical Center, Yuma Regional Cancer Center, 2375 S Ridgeview Dr, Yuma, AZ 85364
| | - Steve Malangone
- University of Arizona Cancer Center, Department of Medicine, Division of Hematology/Oncology, Tucson, AZ, USA
| | - Myke Green
- University of Arizona Cancer Center, Department of Medicine, Division of Hematology/Oncology, Tucson, AZ, USA
| | - Ambuga Badari
- Yuma Regional Medical Center Yuma Regional Cancer Center, Yuma, AZ, USA
| | - Kathryn Clarke
- University of Arizona Cancer Center, Department of Medicine, Division of Hematology/Oncology, Tucson, AZ, USA
| | - Emad Elquza
- University of Arizona, College of Medicine and University of Arizona Cancer Center, Department of Medicine, Division of Hematology/Oncology, Tucson, AZ, USA
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175
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Hepatic epithelioid hemangioendothelioma: Pitfalls in the diagnosis on fine needle cytology and "small biopsy" and review of the literature. Pathol Res Pract 2015; 211:702-5. [PMID: 26187370 DOI: 10.1016/j.prp.2015.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/10/2015] [Accepted: 06/23/2015] [Indexed: 12/26/2022]
Abstract
Hepatic epithelioid hemangioendothelioma is a rare vascular neoplasm with an unpredictable malignant potential. Different therapeutic options are available, depending on the basis of disease extension and the patient's overall condition. A correct pathological diagnosis is necessary and is often based on scant material. Here, we report a case diagnosed on fine needle aspiration and on a small surgical biopsy. In addition, we will review the literature. The patient is a 54-year-old woman who presented with persistent pain in the right hypochondrium and suffered from weight loss. Ultrasound examination and CT scan showed several focal and confluent hepatic lesions. Thus, an ultrasound-guided fine-needle aspiration (US-FNA) was performed. A cytological diagnosis of vascular proliferation with epithelioid component was performed. Afterwards, a hepatic "small biopsy" (SB) was made. Histological and immunohistochemical data were consistent with a hepatic epithelioid hemangioendothelioma diagnosis. The patient, however, is in good general condition and is waiting for a hepatic transplantation; repeated total CT scan showed no signs of metastasis. The literature was reviewed in order to define the pathological features that were helpful in the cytological and histological diagnosis of hepatic epithelioid hemangioendothelioma, and to better understand if pathological data is prognostically useful.
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176
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Zhou L, Cui MY, Xiong J, Dong Z, Luo Y, Xiao H, Xu L, Huang K, Li ZP, Feng ST. Spectrum of appearances on CT and MRI of hepatic epithelioid hemangioendothelioma. BMC Gastroenterol 2015; 15:69. [PMID: 26088585 PMCID: PMC4474347 DOI: 10.1186/s12876-015-0299-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/05/2015] [Indexed: 02/08/2023] Open
Abstract
Background This study aims to analyze the computed tomography (CT) and magnetic resonance imaging(MRI) characteristics of hepatic epithelioid hemangioendothelioma (HEHE). Methods Eleven patients with histopathologically confirmed HEHE via surgical excision or biopsy were included. Imaging findings of these 11 patients were retrospectively analyzed (CT images obtained from all patients and MR images from five patients). Patterns of growth, characteristics of distribution, density/signal features, patterns of contrast enhancement, and changes of adjacent tissues were evaluated. Results HEHE is characterized by multiple lesions in the liver. HEHE could be further categorized as three types when considering patterns of growth: nodular type(5 cases), coalescent type(1 case) and mixed type(5 cases). In this study, a total of 312 lesions were detected, 214(74.3 %) of which were subcapsular. All lesions appeared as hypodense while round lower density were found within 10 lesions(<2 cm) on unenhanced CT images. On MRI, all lesions demonstrated low signal intensity on T1 weighted images and high heterogeneous signal intensity on T2 weighted images when compared to the normal liver parenchyma. Other imaging features included “lollipop sign”(6 cases) and capsular retraction(6 cases). On contrast-enhanced CT and MRI, lesions smaller than 2.0 cm mostly showed mild homogeneous enhancement (214/227, 94.3 %); lesions measuring 2.0–3.0 cm in diameter showed ring-like enhancement (16/53,30.2 %) and heterogeneous delayed enhancement (29/53,54.7 %); lesions larger than 3.0 cm demonstrated heterogeneous delayed enhancement (26/32, 81.3 %). Conclusion The imaging findings of HEHE showed some typical imaging features and size-dependent patterns with contrast enhancement on both CT and MR images, these features can be used for accurate imaging diagnosis of HEHE.
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Affiliation(s)
- Lisha Zhou
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Min-Yi Cui
- Department of Radiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangdong, China.
| | - Juxin Xiong
- Department of Radiology, The Third People's Hospital of Dongguan City, Dongguan, China.
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Hui Xiao
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Ling Xu
- University of Western Australia, Perth, Australia.
| | - Kun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
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177
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Treatment of Hepatic Epithelioid Hemangioendothelioma: Finding Uses for Thalidomide in a New Era of Medicine. Case Rep Gastrointest Med 2015; 2015:326795. [PMID: 26167310 PMCID: PMC4488146 DOI: 10.1155/2015/326795] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/10/2015] [Indexed: 12/12/2022] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEH) is extremely rare, occurring in 1 to 2 per 100,000, with chemotherapy options not well defined. Our case involved a 49-year-old female who had hepatic masses and metastasis to the lungs with a liver biopsy revealing HEH. After developing a rash from sorafenib, thalidomide was started with the progression of disease stabilized. Resection is only an option in 10% of the cases; therefore, chemotherapy is the only line of treatment. Newer chemotherapy alternatives are targeting angiogenesis via the vascular endothelial growth factor. Thalidomide was first used as an antiemetic, but, sadly, soon linked to phocomelia birth defects. Given the mechanism of action against angiogenesis, thalidomide has a valid role in vascular tumors. In conclusion, the use of thalidomide as chemotherapy is novel and promising, especially in the setting of a rare vascular liver tumor such as HEH.
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178
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2014.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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179
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Redaelli D, Guraya SS. Primary hemangioendothelioma of liver; report of a case and review of literature. J Taibah Univ Med Sci 2015. [DOI: 10.1016/j.jtumed.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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180
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Bozkurt O, Demir Ö, Yener S, Tuna B, Seçil M, Yörükoğlu K. Malignant epithelioid hemangioendothelioma of the adrenal gland treated by laparoscopic excision. Urology 2015; 85:e15-6. [PMID: 25733308 DOI: 10.1016/j.urology.2014.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/29/2014] [Accepted: 12/05/2014] [Indexed: 10/23/2022]
Abstract
Epithelioid hemangioendothelioma is a rare vascular tumor mostly seen in liver, lung, and bone. Involvement of the adrenal gland has not been reported previously. Here, we report the first case of adrenal malignant epithelioid hemangioendothelioma in an 81-year-old man who was successfully treated by laparoscopic excision.
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Affiliation(s)
- Ozan Bozkurt
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
| | - Ömer Demir
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Serkan Yener
- Department of Endocrinology and Metabolism, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Burçin Tuna
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mustafa Seçil
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Kutsal Yörükoğlu
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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181
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Briongos-Figuero LS, Zamora-Martínez T. A rare vascular tumor of the liver. Clin Gastroenterol Hepatol 2015; 13:e46-7. [PMID: 25496814 DOI: 10.1016/j.cgh.2014.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/10/2014] [Accepted: 11/25/2014] [Indexed: 02/07/2023]
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182
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Ciliberti MP, Caponio R, Pascali A, Matichecchia G, Lioce M. A rare case of intravascular epithelioid hemangioendothelioma of the cephalic vein treated with surgery and postoperative radiation therapy: a case report and review of the literature. J Med Case Rep 2015; 9:91. [PMID: 25924932 PMCID: PMC4437253 DOI: 10.1186/s13256-015-0565-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 03/04/2015] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Epithelioid hemangioendothelioma (EHE) is a rare endothelial tumor with an intermediate grade of malignancy. Few cases of primary vascular hemangioendothelioma have been described in the literature. Surgery is the treatment of choice, but radiation therapy and chemotherapy should also be considered in particular cases. CASE PRESENTATION We present the case of a 44-year-old Caucasian woman affected by EHE of the cephalic vein, treated by complete surgical removal of the mass and postoperative local radiation therapy. At 5-year follow-up, our patient is alive, with no signs of local or distant relapse and with no late radiation-related effects. CONCLUSIONS Postoperative radiotherapy may play a role in cases in which tumor margins are close or cannot be assessed or when high-risk features are present.
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Affiliation(s)
- Maria Paola Ciliberti
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
| | - Raffaella Caponio
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
| | - Antonio Pascali
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
| | - Gabriele Matichecchia
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
| | - Marco Lioce
- U.O. Radioterapia - National Cancer Research Centre - Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65-70124, Bari, Italy.
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183
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Bally O, Tassy L, Richioud B, Decouvelaere AV, Blay JY, Derbel O. Eight years tumor control with pazopanib for a metastatic resistant epithelioid hemangioendothelioma. Clin Sarcoma Res 2015; 5:12. [PMID: 25969727 PMCID: PMC4428504 DOI: 10.1186/s13569-014-0018-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/04/2014] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Epithelioid hemangioendothelioma is a rare connective tissue tumor of vascular origin. It is most commonly found in young to middle aged women, and its clinical behavior is remakably variable from an indolent metastatic tumor to an aggressive rapidly growing neoplasm. Most tumors are diagnosed in an advanced unresectable phase and when clinically aggressive, require systemic cytotoxic treatment of sarcoma. Then, the 5-year survival rate after chemotherapy does not exceed 30%. Antiangiogenics are active in selected sarcoma subtypes: pazopanib, the only anti angiogenic registered agent for sarcoma provides a median PFS of 4.5 months only in the pivotal study. Their activity in EHE has been reported but long term outcome of these patients remain unreported. We report a case of a female patient with HEH who was treated with pazopanib for almost 8 years. Pazopanib therapy resulted in clinical improvement of symptoms and durable stabilization of liver tumors and lung lesions. CONCLUSION Pazopanib is a promising therapeutic option in patients with HEH.
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Affiliation(s)
- Olivia Bally
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
| | - Louis Tassy
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
| | - Bertrand Richioud
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
| | | | - Jean-Yves Blay
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
| | - Olfa Derbel
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
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184
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Abstract
Liver transplantation (LT) has become an acceptable and effective treatment for selected patients with hepatocellular carcinoma with excellent outcomes. More recently, LT has been tried in different primary and secondary malignancies of the liver. The outcomes of LT for very selected group of patients with hilar cholangiocarcinoma (CCA) have been promising. Excellent results have been reported in LT for patients with unresectable hepatic epithelioid hemangioendothelioma (HEHE). In contrast to excellent results after LT for HEHE, results of LT for angiosarcoma have been disappointing with no long-term survivors. Hepatoblastoma (HB) is the most common primary liver cancer in pediatric age group. Long-term outcomes after LT in patients with unresectable tumor and good response to chemotherapy have been promising. Indication for LT for hepatic metastasis from neuroendocrine tumors (NETs) is mainly for patients with unresectable tumors and for palliation of medically uncontrollable symptoms. Posttransplant survival in those patients with low tumor activity index is excellent, despite recurrence of the tumor. More recent limited outcomes data on LT for unresectable hepatic metastases from colorectal cancer have claimed some survival benefit compared to the previous reports. However, due to the high rate of tumor recurrence in a very short time after LT, especially in the era of organ shortage, this indication has not been favored by the transplant community.
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185
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Ressurreição J, Matos C, Bali M. Rapid Progression of Multifocal Hepatic Epithelioid Hemangioendothelioma. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:123-125. [PMID: 28868390 PMCID: PMC5580116 DOI: 10.1016/j.jpge.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/05/2015] [Indexed: 11/17/2022]
Affiliation(s)
- João Ressurreição
- Radiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Radiology Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Corresponding author.
| | - Celso Matos
- Radiology Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Bali
- Radiology Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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186
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Zhang DY, Weng SQ, Dong L, Shen XZ. Eosinophilic pseudotumor of the liver: report of six cases and review of literature. J Dig Dis 2015; 16:159-63. [PMID: 25214005 DOI: 10.1111/1751-2980.12189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Dan Ying Zhang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
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187
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Schweitzer N, Soudah B, Gebel M, Manns MP, Boozari B. Gray scale and contrast-enhanced ultrasound imaging of malignant liver tumors of vascular origin. United European Gastroenterol J 2015; 3:63-71. [PMID: 25653860 DOI: 10.1177/2050640614560604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Malignant vascular tumors of the liver are rare. The aim of this study was to investigate the applicability of gray scale and contrast-enhanced ultrasonography in patients with epithelioid hemangioendothelioma (EHE) of the liver and hepatic angiosarcoma (HA) and to describe the clinical presentation. METHODS We retrospectively analyzed all patients with epithelioid hemangioendothelioma or hemangiosarcoma of the liver from 1998 to 2011, who underwent ultrasound investigation. We describe the findings in gray scale and contrast-enhanced ultrasound and the clinical course of the disease of seven patients with EHE and five patients with HA. RESULTS Ultrasound investigation in EHE showed mostly multiple hypoechoic irregular lesions close to the liver capsule and with a halo in some cases. Contrast enhancement revealed inhomogeneously and through all contrast phases vascularized tumors with a rim enhancement in 50%, with or without early wash out. All tumors had avascular parts. HA presented as multiple and irregular hypo-, iso- or hyperechoic lesions. After contrast enhancement, hypervascularization with individual patterns was evident in all patients. Of five, three had liquid parts. Patients with HA were significantly older (58 vs. 37 years, p = 0.014) and presented with lower thrombocyte counts (84 vs. 264, p = 0.0025) and with higher CEA levels (4.6 vs. 1.5, p = 0.03). CONCLUSION EHE and HA are inhomogeneous tumors, explaining the high inter-individual variability and heterogeneity in ultrasound examination. The presence of multifocal lesions, heterogeneity and undefined margins may differentiate EHE or HA from hemangioma. A biopsy is essential in the diagnosis of vascular tumors.
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Affiliation(s)
- Nora Schweitzer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Bisharah Soudah
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Michael Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael Peter Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Bita Boozari
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany ; Department of Internal Medicine I, Medical University Hospital Tuebingen, Tuebingen, Germany
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188
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Kriger AG, Dan VN, Tsygankov VN, Berelavichus SV, Akhtanin EA, Kalinin DV, Tereshchenko AD. [Epithelioid hemangioma of inferior vena cava]. Khirurgiia (Mosk) 2015:82-86. [PMID: 26031826 DOI: 10.17116/hirurgia2015282-86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A G Kriger
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - V N Dan
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - V N Tsygankov
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | | | - E A Akhtanin
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - D V Kalinin
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
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189
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[Intra-abdominal soft tissue tumors. What needs to be known to reach the diagnosis with the help of immunohistochemistry, FISH and molecular biology]. Ann Pathol 2014; 35:114-25. [PMID: 25541116 DOI: 10.1016/j.annpat.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/25/2014] [Indexed: 11/22/2022]
Abstract
Connective tissue tumors located inside the abdomen are a rare heterogeneous group of tumors, except for gastro-intestinal stromal tumors. They may be benign, malignant, or intermediate in terms of biologic potential. Pathologists have to remember the list of all the lesions possibly involved, with their immunohistochemical characteristics, and to know which molecular analyses are needed, with which expected results, and by which team they can be performed. The main tumor types are discussed with diagnostic tools and treatment consequences.
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190
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Cazorla A, Félix S, Delabrousse E, Valmary-Degano S. [Primary hepatic angiosarcoma: A retrospective analysis of eight cases]. Ann Pathol 2014; 34:462-8. [PMID: 25499861 DOI: 10.1016/j.annpat.2014.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
Angiosarcoma is a malignant tumor of vascular endothelial cell origin. Primary hepatic angiosarcoma is rare, most often associated with chronic exposure to toxic substances. The diagnosis of angiosarcoma is based on histological examination. Presenting symptoms are nonspecific, including abdominal pain, impaired general condition and fever. Primary hepatic angiosarcoma is a fast-growing tumor and the diagnosis is usually made at an advanced stage of the disease. The prognosis is poor. Surgical resection is recommended as the curative choice in localized forms, highlighting the key role of screening programs of occupational medicine that may help to diagnose tumors at an earlier, localized stage. Radiotherapy and chemotherapy are considered to have a limited efficacy. Here, we report a series of eight cases of primary hepatic angiosarcoma diagnosed at the University Hospital of Besançon between 2001 and 2012. Clinical, radiological, histological and therapeutic characteristics of the patients are described and analyzed.
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Affiliation(s)
- Arnault Cazorla
- Service de pathologie, CHRU de Besançon, 2, boulevard A.-Fleming, 25000 Besançon, France
| | - Sophie Félix
- Service de pathologie, CHRU de Besançon, 2, boulevard A.-Fleming, 25000 Besançon, France
| | - Eric Delabrousse
- Service de radiologie, CHRU de Besançon, 2, boulevard A.-Fleming, 25000 Besançon, France
| | - Séverine Valmary-Degano
- Service de pathologie, CHRU de Besançon, 2, boulevard A.-Fleming, 25000 Besançon, France; EA3181, SFR4234, université de Franche-Comté, 25000 Besançon, France.
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191
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Vasudevan G, Nayal B, Nagel B, Rao L. Hepatic Epithelioid Hemangioendothelioma in an Eight Year old - A Case Report. J Clin Diagn Res 2014; 8:FD01-2. [PMID: 25653958 PMCID: PMC4316264 DOI: 10.7860/jcdr/2014/9910.5267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/24/2014] [Indexed: 11/24/2022]
Abstract
Hepatic epithelioid haemangio-endothelioma (HEHE) is a rare vascular tumour of endothelial origin. The etiology of this tumour is unknown and has a variable clinical outcome. It usually affects adults and is extremely rare in children. Histologically, HEHE is characterized by epithelioid to dendritic tumour cells with intracytoplasmic lumina containing RBCs and a myxoid to sclerotic stroma. Being a rare entity, awareness and a high degree of suspicion is required to correctly identify this tumour. We report a case of hepatic hemangioendothelioma in an 8-year-old child.
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Affiliation(s)
- Geetha Vasudevan
- Additional Professor, Department of Pathology, Kasturba Medical College, Manipal University, Manipal. Karnataka, India
| | - Bhavna Nayal
- Assistant Professor, Department of Pathology, Kasturba Medical College, Manipal University, Manipal. Karnataka, India
| | - Bhawna Nagel
- Junior Resident, Department of Pathology, Kasturba Medical College, Manipal University, Manipal. Karnataka, India
| | - Lakshmi Rao
- Professor, Department of Pathology, Kasturba Medical College, Manipal University, Manipal. Karnataka, India
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192
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Epithelioid hemangioendothelioma presenting as malignant biliary stricture. J Gastrointest Cancer 2014; 45 Suppl 1:275-7. [PMID: 25358550 DOI: 10.1007/s12029-014-9660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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193
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Grover I, Ahmad N, Googe AB. Hepatogastric Fistula following Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma. Case Rep Gastroenterol 2014; 8:286-90. [PMID: 25408632 PMCID: PMC4224249 DOI: 10.1159/000368302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Hepatogastric fistula (HGF) formation following transcatheter arterial chemoembolization (TACE) leads to increased morbidity and mortality. A 51-year-old Caucasian male with chronic hepatitis B virus-associated cirrhosis and unresectable hepatocellular carcinoma (HCC) presented to the Interventional Radiology Unit for TACE to achieve tumor necrosis. Following the procedure, the patient was admitted with symptoms of fever, epigastric and right upper quadrant pain secondary to the development of an abscess. The abscess was drained; however, an exceedingly rare HGF resulted that was favored to represent a direct invasion of HCC. HGF, the rare complication following TACE, leads to grave consequences and vigilant monitoring, for the development of this entity is recommended to reduce patient mortality. We present a case and literature review of HGF development following TACE for HCC.
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Affiliation(s)
- Inderpreet Grover
- Internal Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Miss., USA
| | - Naveed Ahmad
- Department of Gastroenterology, Indiana University Health Arnett, Lafayette, Ind., USA
| | - Amber B Googe
- University of Mississippi Medical Center, Jackson, Miss., USA
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194
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Lamba R, Fananazapir G, Corwin MT, Khatri VP. Diagnostic Imaging of Hepatic Lesions in Adults. Surg Oncol Clin N Am 2014; 23:789-820. [DOI: 10.1016/j.soc.2014.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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195
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Bhoori S, Mazzaferro V. Current challenges in liver transplantation for hepatocellular carcinoma. Best Pract Res Clin Gastroenterol 2014; 28:867-79. [PMID: 25260314 DOI: 10.1016/j.bpg.2014.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/14/2014] [Indexed: 01/31/2023]
Abstract
Liver transplantation (LT) is the best option of cure for hepatocellular carcinoma (HCC). Notwithstanding several alternatives, Milan Criteria remain the cornerstone for patient selection. Currently, expanded criteria patients are unsuitable for LT without taking downstaging approaches and response to therapies into consideration. Relative weight of HCC as indication to LT is increasing and that generates competition with MELD-described non-cancer indications. Allocation policies should be adjusted accordingly, considering principles of urgency and utility in the management of the waiting list and including transplant benefit to craft equitable criteria to deal with the limited resource of donated grafts. Maximization of cost-effectiveness of LT in HCC can be also pursued through changes in immunosuppression policies and multimodal management of post-transplant recurrences. This review is focused on those constantly mutating challenges that have to be faced by anyone dealing with the management of HCC in the context of liver transplantation.
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Affiliation(s)
- Sherrie Bhoori
- Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS, National Cancer Institute, Via Venezian 1, Milan 20133, Italy
| | - Vincenzo Mazzaferro
- Gastroenterology, Surgery and Liver Transplantation Unit, Fondazione Istituto Nazionale Tumori IRCCS, National Cancer Institute, Via Venezian 1, Milan 20133, Italy.
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196
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Diffuse hepatic epithelioid hemangioendothelioma developed in a patient with hepatitis C cirrhosis. Case Rep Transplant 2014; 2014:694903. [PMID: 25276467 PMCID: PMC4172934 DOI: 10.1155/2014/694903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/28/2014] [Indexed: 01/26/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is an infrequent vascular tumor of endothelial origin that primarily occurs in women in the mid-fifth decade of life without underlying chronic liver disease or cirrhosis. Liver transplant should be the first-line of therapy in patients with large or diffuse unresectable tumors even in the presence of metastatic disease due to the favorable long-term outcome. We report the case of a 48-year-old female who complained of abdominal pain and weight loss. She has a history of cirrhosis secondary to chronic hepatitis C (HCV) and was treated with interferon and ribavirin with sustained virological response. Her work-up revealed multiple confluent infiltrating bilobar liver masses diagnosed as HEHE. She underwent a successful liver transplant without evidence of recurrent HCV infection. She developed cervical spine (C4-C6) HEHE metastases 4 years after transplant. She underwent surgical resection and local radiotherapy after resection with good clinical response. To the best of our knowledge, this is the first report of HEHE that developed in a patient with HCV cirrhosis successfully treated with antiviral therapy before transplant and liver transplant with good allograft function without evidence of recurrent liver tumor or HCV infection but developed metastases to the cervical spine 4 years after transplant.
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197
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Remiszewski P, Szczerba E, Kalinowski P, Gierej B, Dudek K, Grodzicki M, Kotulski M, Paluszkiewicz R, Patkowski W, Zieniewicz K, Krawczyk M. Epithelioid hemangioendothelioma of the liver as a rare indication for liver transplantation. World J Gastroenterol 2014; 20:11333-11339. [PMID: 25170219 PMCID: PMC4145773 DOI: 10.3748/wjg.v20.i32.11333] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/25/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the indications and outcomes of liver transplantation for hepatic epithelioid hemangioendothelioma (HEHE).
METHODS: Between 1989 and August 2013, in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1306 orthotopic liver transplantations (OLTx) were performed, including 72 retransplantations. Unresectable HEHE was an indication for OLTx in 10 patients (0.8% of primary OLTx), the mean age of the patients was 40.5 ± 13.3 years (range 23-65 years), and the male-to-female ratio was 2:8. Kaplan-Meier survival analysis in HEHE, hepatocellular carcinoma (HCC), and other OLTx recipients groups was performed. The differences in mortality were compared using the χ2 test. A P-value < 0.05 indicated statistical significance.
RESULTS: No concomitant liver disease was found in any patient. There was no neoadjuvant chemotherapy or radiotherapy. Liver function test results were normal in most of the patients. The levels of alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 were normal. In immunohistochemical staining, the neoplastic cells were positive for factor VIII-related antigen, CD31, and CD34, which are endothelial cell markers, and negative for cytokeratin 19, cytokeratin 7, and HepPar-1. Nine patients were alive without tumor recurrence. One patient died 2 mo after OLTx due to septic complications. No morbidity was observed. Maximum follow-up was 11.4 years, with a minimum of 1 mo. The cumulative survival rate at the end of follow-up in HEHE patients was 87.5% compared with 54.3% in the HCC group and 76.3% in the other OLTx recipients group (χ2 test = 1.784, df = 2, P = 0.409).
CONCLUSION: Unresectable HEHE, without extrahepatic metastases is an excellent indication for liver transplantation. Long-term survival is very good and much better than in HCC patients and the entire group of OLTx patients.
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198
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Abstract
Vascular tumors are rare in children and adults. Classification of these tumors has been difficult, especially in the pediatric population, due to the rarity of these lesions, the unusual morphologic appearance, their diverse clinical behavior, and no independent stratification for pediatric tumors. In 2013, The World Health Organization updated the classification of soft tissue vascular tumors. Pediatric tumors were not independently stratified and the terminology was mostly left unchanged, but the intermediate category of tumors was divided into locally aggressive and rarely metastasizing. These tumors are treated with multimodality therapy and therefore need the guidance of an interdisciplinary team for best care.
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Affiliation(s)
- Denise M Adams
- Cancer and Blood Disease Institute, Cincinnati Children׳s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio; Hemangioma and Vascular Malformation Center, Cincinnati Children׳s Hospital Medical Center, 3333 Burnett Ave, Cincinnati, Ohio, 45229.
| | - Adrienne Hammill
- Cancer and Blood Disease Institute, Cincinnati Children׳s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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199
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Komatsu S, Iwasaki T, Demizu Y, Terashima K, Fujii O, Takebe A, Toyokawa A, Teramura K, Fukumoto T, Ku Y, Fuwa N. Two-stage treatment with hepatectomy and carbon-ion radiotherapy for multiple hepatic epithelioid hemangioendotheliomas. World J Gastroenterol 2014; 20:8729-8735. [PMID: 25024633 PMCID: PMC4093728 DOI: 10.3748/wjg.v20.i26.8729] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/10/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEH) is a rare neoplasm of vascular origin with variable malignant potential. Because most patients with this condition have multiple bilobar lesions, liver transplantation is the standard treatment, and hepatectomy is much less frequently indicated. We describe a case of a 35-year-old woman with unresectable multiple bilobar HEH successfully treated by combination treatment with hepatectomy and carbon-ion radiotherapy. This case is very meaningful since it demonstrated the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.
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200
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Deng Y, Zhou Y, Cheng N. Laparoscopic liver biopsy in the diagnosis of hepatic epithelioid hemangioendothelioma: A case report. Oncol Lett 2014; 8:1317-1319. [PMID: 25120715 PMCID: PMC4114635 DOI: 10.3892/ol.2014.2308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/23/2014] [Indexed: 02/05/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEH) is a rare vascular tumor of the liver, and its definitive diagnosis is completely dependent on histopathological verification. In the present study, we report the case of a patient whose percutaneous liver biopsy failed to reveal a diagnosis of HEH, twice, and who was ultimately diagnosed by laparoscopic liver biopsy. The patient was a 42-year-old female with mild right upper quadrant discomfort. Ultrasonography and magnetic resonance imaging showed multiple mass lesions scattered throughout the liver, but no evidence of extrahepatic diseases. The initial laboratory tests included liver function tests and tumor markers were within normal limits. Subsequently, two, ultrasound (US)-guided liver biopsies from the liver lesion were performed using an 18-gauge needle, and both of these showed massive hepatocellular necrosis. To obtain adequate tissue samples for histological examination, the patient underwent laparoscopic liver biopsy. The overall immunohistochemical findings supported the diagnosis of HEH. In the present case, two, US-guided percutaneous liver biopsies failed to diagnose HEH, and laparoscopic liver biopsy was safely performed to obtained adequate specimens for analysis. Although this method is not the preferred technique and has certain disadvantages, it is considered to be a useful and minimally invasive approach for liver lesions when other less-invasive diagnostic modalities fail or are difficult to be performed.
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Affiliation(s)
- Yilei Deng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yong Zhou
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Nansheng Cheng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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