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Grimaldi C, de Ville de Goyet J, Bici K, Cianci MC, Callea F, Morabito A. The role of liver transplantation in the care of primary hepatic vascular tumours in children. Front Oncol 2022; 12:1026232. [PMID: 36505841 PMCID: PMC9730342 DOI: 10.3389/fonc.2022.1026232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Liver transplantation (LT) is the standard of care for many liver conditions, such as end-stage liver diseases, inherited metabolic disorders, and primary liver malignancies. In the latter group, indications of LT for hepatoblastoma and hepatocellular carcinoma evolved and are currently available for many non-resectable cases. However, selection criteria apply, as the absence of active metastases. Evidence of good long-term outcomes has validated the LT approach for managing these malignancies in the context of specialist and multidisciplinary approach. Nevertheless, LT's role in treating primary vascular tumours of the liver in children, both benign and malignant, remains somewhat controversial. The rarity of the different diseases and the heterogeneity of pathological definitions contribute to the controversy and make evaluating the benefit/risk ratio and outcomes quite difficult. In this narrative review, we give an overview of primary vascular tumours of the liver in children, the possible indications and the outcomes of LT.
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Affiliation(s)
- Chiara Grimaldi
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy,*Correspondence: Chiara Grimaldi,
| | - Jean de Ville de Goyet
- Department of Pediatrics, IRCCS-Istituto Mediterraneo per i Trapianti e Terapie ad altra specializzazione (ISMETT) (Institute for Scientific-Based Care and Research-Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Maria Chiara Cianci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Francesco Callea
- Department of Histopathology, Bugando Medical Centre, Catholic University of Healthy Allied Sciences, Mwanza, Tanzania
| | - Antonino Morabito
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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Dobrindt EM, Öllinger R, Flörcken A, Märdian S, Schmelzle M, Lurje G, Pratschke J, Schoening W. Primäre Lebersarkome – Empfehlungen zur chirurgischen Therapie. Zentralbl Chir 2022; 148:165-179. [PMID: 35211924 DOI: 10.1055/a-1728-6939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eva Maria Dobrindt
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Robert Öllinger
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Anne Flörcken
- Medizinische Klinik m.S. Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sven Märdian
- Zentrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Moritz Schmelzle
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Georg Lurje
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Johann Pratschke
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wenzel Schoening
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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3
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Chen PK, Lin QT, Feng YZ, Weng ZP, Cai XR. Epithelioid hemangioendothelioma of spine: A case report with review of literatures. Radiol Case Rep 2020; 15:2687-2692. [PMID: 33117468 PMCID: PMC7581828 DOI: 10.1016/j.radcr.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 01/07/2023] Open
Abstract
Primary epithelioid hemangioendothelioma of the spine is the extremely rare malignant vascular neoplasm with an unpredictable outcome. A case of epithelioid hemangioendothelioma with multiple lytic lesions of thoracolumbar spine and other bones in a 29-year-old male patient is reported. A review of the published data regarding this rare neoplasm is also presented. The features of epithelioid hemangioendothelioma include the occurrence in the young male patient, multiple osteolytic lesions with thin sclerotic rim and hypermetabolic activities. However, its imaging features are not specific. Positron emission tomography/computed tomography is essential for identification of the lesions and subsequent follow-up for treatment.
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Affiliation(s)
- Ping-Kang Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - Qi-Ting Lin
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - You-Zhen Feng
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
| | - Ze-Ping Weng
- Department of Pathology, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Xiang-Ran Cai
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, Guangdong, China
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Brahmbhatt M, Prenner S, Bittermann T. Liver Transplantation for Hepatic Epithelioid Hemangioendothelioma Is Facilitated by Exception Points With Acceptable Long-term Outcomes. Transplantation 2020; 104:1187-1192. [PMID: 31577674 DOI: 10.1097/tp.0000000000002982] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor with a high mortality rate. HEHE is now a formally recognized indication for exception point priority in the United States under the new National Liver Review Board. The role of liver transplantation (LT) and exception point waitlist priority in the United States for patients with HEHE remains understudied. METHODS This was a retrospective cohort study using the United Network for Organ Sharing transplant database. From February 27, 2002 to January 31, 2018, 131 adults waitlisted for LT with HEHE were identified by free-text entry. RESULTS Exception point applications were submitted for 91.6% (120/131) of patients. All patients with fully reviewed applications received exception points at least once during waitlisting, and 85% (103/120) upon first submission. Among the 88 patients transplanted, median model for end-stage liver disease score at LT was 7 ((interquartile range [IQR]: 6-11) and waiting time 78.5 days (IQR: 29.5-237.5). Unadjusted post-LT survival of HEHE recipients at 1-, 3-, and 5-years from LT was 88.6%, 78.9%, and 77.2%. Unadjusted post-LT patient and graft survival of HEHE patients was not different from patients with hepatocellular carcinoma within Milan receiving exception point priority (P = 0.08). An increased rate of graft failure due to hepatic artery thrombosis ≤14 days from initial LT was observed in HEHE versus non-HEHE patients (4.6% versus 0.5%). CONCLUSIONS The majority of HEHE recipients receive exception points at a universal approval rate allowing prompt access to deceased donor LT.
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Affiliation(s)
- Mihir Brahmbhatt
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stacey Prenner
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Therese Bittermann
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
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Kuan LL, Tan LT, Jepson S, Pollard C, Dennison AR. A case of recurrent hepatic haemangioendothelioma. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 32735126 DOI: 10.1308/rcsann.2020.0150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Hepatic haemangioendothelioma is a rare (1:1,000,000) mesenchymal tumour of the liver of vascular origin. Metastatic malignancies, other primary liver tumours and cholangiocarcinomas all have significantly worse prognoses and may mimic hepatic haemangioendothelioma. Hence, careful pathological assessment with appropriate tumour markers and immunohistochemistry are essential. We present a rare case of recurrence of hepatic haemangioendothelioma after 10 years post-hemihepatectomy. Surgical approaches include liver resection, liver transplantation and ablative techniques with chemotherapy and radiotherapy reserved for patients where a surgical approach is not possible. Hepatic haemangioendothelioma has an unpredictable course that is generally indolent and it is associated with a significantly better long-term survival. Consequently, it is important that these tumours are recognised and the approach to the diagnosis should be methodical. Owing to the protracted course of the disease, a prolonged duration of surveillance and an aggressive approach towards disease recurrence are essential for long-term survival.
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Affiliation(s)
- L L Kuan
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.,The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia
| | - L T Tan
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - S Jepson
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C Pollard
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Liu Z, Yi L, Chen J, Li R, Liang K, Chen X, Li R, Long W. Comparison of the clinical and MRI features of patients with hepatic hemangioma, epithelioid hemangioendothelioma, or angiosarcoma. BMC Med Imaging 2020; 20:71. [PMID: 32600273 PMCID: PMC7322860 DOI: 10.1186/s12880-020-00465-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/04/2020] [Indexed: 01/02/2023] Open
Abstract
Background Comparisons of hepatic epithelioid hemangioendothelioma (HEHE), hepatic hemangioma, and hepatic angiosarcoma (HAS) have rarely been reported. The purpose of our study was to analyze the clinical and magnetic resonance imaging (MRI) findings of these conditions. Methods A total of 57 patients (25 with hemangioma, 13 with HEHE, and 19 with HAS) provided hepatic vascular endothelial cell data between June 2006 and May 2017. Results The proportions of cases with circumscribed margins were 88% (22/25), 84.6% (11/13), and 31.6% (6/19) for hemangioma, HEHE, and HAS, respectively (P < 0.001). HAS lesions were less likely to have circumscribed margins. The proportions of lesions with hemorrhaging were 4% (1/25), 30.8% (4/13), and 36.8% (7/19) for hemangioma, HEHE, and HAS, respectively (P = 0.014). HEHE and HAS cases were more likely to show heterogeneous signals on T1-weighted (T1WI) MRI. HEHE and HAS cases were more likely to show heterogeneous signals on T2-weighted (T2WI) MRI. Centripetal enhancement was the most common pattern in vascular tumors, with proportions of 100, 46.2% (6/13), and 68.4% (13/19) for hemangioma, HEHE, and HAS, respectively. The difference in enhancement pattern between HEHE and HAS was not significant, but rim enhancement was more common for HEHE (46.2%, 6/13). Conclusions Our study revealed clinical and imaging differences between HEHE and HAS. The platelet count (PLT) and coagulation function of the HAS group decreased, whereas the alpha-fetoprotein (AFP) level increased. The 5-year survival rate for HAS was significantly lower than that of HEHE. A higher malignancy degree indicated a more blurred lesion margin, easier occurrence of hemorrhaging, and more heterogeneous T1WI and T2WI signals.
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Affiliation(s)
- Zhuangsheng Liu
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Lilei Yi
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Junhao Chen
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Ruqiong Li
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Keming Liang
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Xiangmeng Chen
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China.
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Hepatic Epithelioid Hemangioendothelioma as a Rare Indication for Liver Transplantation. Transplant Proc 2020; 52:1453-1454. [PMID: 32241636 DOI: 10.1016/j.transproceed.2020.01.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (HEHE) is a rare neoplasm of vascular origin, with nonspecific presentation and unpredictable clinical course. Several therapeutic options are available according to the literature, including chemotherapy and radiotherapy, liver resection (LR), and liver transplantation (LT). METHODS We present 2 cases of patients with HEHE treated with liver transplantation in our center, a 30-year-old man and a 42-year-old woman, diagnosed with several lesions involving both liver lobes. RESULTS Levels of tumor markers (carcinoembryonic antigen [CEA], cancer antigen 19.9 [Ca19.9], and alpha-fetoprotein [AFP]) were negative. Percutaneous biopsy revealed HEHE in both cases. Due to the bilobar location, liver transplantation was performed. Postoperative course was unremarkable, and no significant complications developed. At this time, 10 and 5 years' follow-up has concluded, respectively. Both patients remain alive, asymptomatic, with normal liver function and no sign of recurrence. CONCLUSIONS HEHE is an uncommon malignant hepatic disease. Most cases present with bilobar involvement, and LT is probably the most useful treatment with favorable outcomes according to the literature and our experience. Further studies are needed to establish the optimal management of this rare entity.
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Telli TA, Okten IN, Tuylu TB, Demircan NC, Arikan R, Alan O, Ercelep O, Ones T, Yildirim AT, Dane F, Yumuk PF. VEGF-VEGFR pathway seems to be the best target in hepatic epithelioid hemangioendothelioma: A case series with review of the literature. Curr Probl Cancer 2020; 44:100568. [PMID: 32201052 DOI: 10.1016/j.currproblcancer.2020.100568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 12/15/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor originating from endothelial cells. Clinical aspect of the disease covers a wide spectrum from a low-grade tumor to a fatal cancer. Most common sites of EHE are reported as lung, liver and bone. Hepatic EHE (HEHE) is a clinical form with an incidence of less than 1 person in a million. Due to rarity of the disease, there is no standard therapy established. Surgery and liver transplantation still seem to be the best approach if possible. However, most of the patients present with unresectable or metastatic disease. Many conventional chemotherapeutic agents and antiangiogenic drugs have been reported previously in the literature with inconsistent outcomes. Here we report 4 cases of HEHE, who benefit distinctly from anti-VEGF treatments in different settings. While combination of paclitaxel and bevacizumab resulted in partial response in 3 patients, one of them also achieved long-term disease stabilization with bevacizumab maintenance with no adverse event. Two of the patients had clear benefit from pazopanib during the course of disease. One patient was treated with thalidomide for 18 months with stable disease, and is still being followed without any treatment. Although targeting VEGF-VEGFR pathway seems to be the best approach in HEHE, randomized studies are urgently needed to support these findings.
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Affiliation(s)
- Tugba Akin Telli
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ilker Nihat Okten
- Division of Medical Oncology, Department of Internal Medicine, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Tuğba Basoglu Tuylu
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Nazim Can Demircan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Rukiye Arikan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozkan Alan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozlem Ercelep
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tunc Ones
- Department of Nucleer Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Faysal Dane
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
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Challenges in Management of Epithelioid Hemangioendothelioma of the Spine: The Report of a Rare Cause of Cauda Equina Syndrome. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.85206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Epelboym Y, Engelkemier DR, Thomas-Chausse F, Alomari AI, Al-Ibraheemi A, Trenor CC, Adams DM, Chaudry G. Imaging findings in epithelioid hemangioendothelioma. Clin Imaging 2019; 58:59-65. [PMID: 31238187 DOI: 10.1016/j.clinimag.2019.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/28/2019] [Accepted: 06/11/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE-OBJECTIVE Epithelioid hemangioendothelioma (EHE) is a rare vascular malignancy with varying biologic behavior. The purpose of this study was to identify imaging findings most characteristic of EHE. METHODS Retrospective review of clinical and imaging records in patients referred to our Vascular Anomalies Center over a 17 year period with biopsy proven EHE. RESULTS We evaluated 29 patients (17 F) with median age of 16 years (range 2-76 y). The most common presenting symptoms were pain (n = 13) and palpable mass (n = 7). 22 (70%) had multifocal disease. Most common sites of involvement were lung (n = 25), liver (n = 16), bone (n = 12), soft tissue (n = 3) and lymph nodes (n = 1). Of patients with single site disease, 3 had lung, 3 liver, and 1 had bone lesions. In 18/25 with lung disease, there were multiple nodules of varying sizes and characteristics. In 14/16 with hepatic disease there were multiple nodules with predominantly peripheral distribution. Subcapsular retraction was seen in 10/16 and a "lollipop" sign (hepatic or portal vein tapering at the edge of a well-defined hypoenhancing lesion) identified in 5/16. Of 12 osseous lesions, 11 were lytic, 8 involved vertebrae and 9 involved the axial skeleton. CONCLUSION EHE has varied imaging findings. The most common sites are lungs, liver, and bone, with multi-organ involvement seen in most. Lung disease is most commonly characterized by multiple nodules. Hepatic lesions demonstrate the most distinctive findings, with peripheral distribution, lack of early enhancement, subcapsular retraction and "lollipop" sign. Osseous lesions are commonly lytic and more prevalent in the axial skeleton.
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Affiliation(s)
- Yan Epelboym
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Dawn R Engelkemier
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Frederic Thomas-Chausse
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Cameron C Trenor
- Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Denise M Adams
- Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America
| | - Gulraiz Chaudry
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, United States of America; Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, United States of America.
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11
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Panick CE, Ward RD, Coppa C, Liu PS. Hepatic capsular retraction: An updated MR imaging review. Eur J Radiol 2019; 113:15-23. [DOI: 10.1016/j.ejrad.2019.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023]
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12
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Llueca A, Piquer D, Maazouzi Y, Medina C, Delgado K, Serra A, Escrig J. Hepatic epithelioid hemangioendothelioma: A great mimicker. Int J Surg Case Rep 2018; 53:25-28. [PMID: 30366173 PMCID: PMC6205146 DOI: 10.1016/j.ijscr.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Epithelioid hemangioendothelioma is a malignant mesenchymal tumor of unknown etiology. They tend to be asymptomatic or with non-specific symptoms. The lesion is usually multiple and variable size. PRESENTATION OF CASE We describe a clinical case of a 23-years-old patient diagnosed with a pelvic mass, a possible uterine fibroid or adnexal mass, and multiple liver lesions that seemed an advanced ovarian cancer presentation and after liver biopsy turned out to be a hepatic epithelioid hemangioendothelioma. DISCUSSION It may be confused with a metastatic process in diagnostic imaging. There have been described some possible risk factors but the etiology remains unknown. The prognosis is usually lethal in 50% of cases. The surgical removal of the lesion and liver transplant appear to be the only hope for these patients. CONCLUSION Epithelioid hemangioendothelioma must be part of our differential diagnosis when we find a liver tumour, especially in young women. Treatment is excision of the tumour in limited disease. In the case of unresectable disease are candidates for liver transplantation.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain.
| | - Dolors Piquer
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Yasmine Maazouzi
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Carmen Medina
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
| | - Javier Escrig
- Multidisciplinary Unit for Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Spain; Dept. of Medicine, University Jaume I (UJI), Castellon de la Plana, Spain
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13
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Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT. AJR Am J Roentgenol 2018; 211:76-86. [DOI: 10.2214/ajr.18.19704] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Hettmer S, Andrieux G, Hochrein J, Kurz P, Rössler J, Lassmann S, Werner M, von Bubnoff N, Peters C, Koscielniak E, Sparber-Sauer M, Niemeyer C, Mentzel T, Busch H, Boerries M. Epithelioid hemangioendotheliomas of the liver and lung in children and adolescents. Pediatr Blood Cancer 2017; 64. [PMID: 28598585 DOI: 10.1002/pbc.26675] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/03/2017] [Accepted: 05/10/2017] [Indexed: 12/12/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare, vascular sarcoma. Visceral forms arise in the liver/ lungs. We review the clinical and molecular phenotype of pediatric visceral EHE based on the case of a 9-year-old male child with EHE of the liver/lungs. His tumor expressed the EHE-specific fusion oncogene WWTR1-CAMTA1. Molecular characterization revealed a low somatic mutation rate and activated interferon signaling, angiogenesis regulation, and blood vessel remodeling. After polychemotherapy and resection of lung tumors, residual disease remained stable on oral lenalidomide. Literature review identified another 24 children with EHE of the liver/lungs. Most presented with multifocal, systemic disease. Only those who underwent complete resection achieved complete remission. Four children experienced rapid progression and died. In six children, disease remained stable for years without therapy. Two patients died from progressive EHE 21 and 24 years after first diagnosis. Natural evolution of pediatric visceral EHE is variable, and long-term prognosis remains unclear.
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Affiliation(s)
- Simone Hettmer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Freiburg, Germany
| | - Geoffroy Andrieux
- Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany
| | - Jochen Hochrein
- Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany
| | - Philipp Kurz
- Comprehensive Cancer Center Freiburg, Freiburg, Germany.,Institute of Surgical Pathology, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Rössler
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Freiburg, Germany
| | - Silke Lassmann
- German Cancer Consortium (DKTK), Partner site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Freiburg, Germany.,Institute of Surgical Pathology, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Werner
- German Cancer Consortium (DKTK), Partner site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Freiburg, Germany.,Institute of Surgical Pathology, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolas von Bubnoff
- German Cancer Consortium (DKTK), Partner site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Freiburg, Germany.,Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Peters
- German Cancer Consortium (DKTK), Partner site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Freiburg, Germany.,Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany
| | - Ewa Koscielniak
- Klinikum Stuttgart, Zentrum für Kinder und Jugendmedizin, Olgahospital, Pediatrics 5 (Pediatric Oncology, Hematology, Immunology), Stuttgart, Germany.,Department of Pediatric Oncology, University Children's Hospital, Tuebingen, Germany
| | - Monika Sparber-Sauer
- Klinikum Stuttgart, Zentrum für Kinder und Jugendmedizin, Olgahospital, Pediatrics 5 (Pediatric Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Charlotte Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner site Freiburg, Freiburg, Germany
| | - Thomas Mentzel
- Dermapathologische Gemeinschaftspraxis, Friedrichshafen, Germany
| | - Hauke Busch
- German Cancer Consortium (DKTK), Partner site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Freiburg, Germany.,Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Lübeck Institute of Experimental Dermatology, Lübeck, Germany
| | - Melanie Boerries
- German Cancer Consortium (DKTK), Partner site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg, Freiburg, Germany.,Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Haydon E, Haydon G, Bramhall S, Mayer AD, Niel D. Hepatic Epithelioid Haemangioendothelioma. J R Soc Med 2017; 98:364-5. [PMID: 16055903 PMCID: PMC1181838 DOI: 10.1177/014107680509800810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Lee JH, Jeong WK, Kim YK, Lee WJ, Ha SY, Kim KW, Kim J. Magnetic resonance findings of hepatic epithelioid hemangioendothelioma: emphasis on hepatobiliary phase using Gd-EOB-DTPA. Abdom Radiol (NY) 2017; 42:2261-2271. [PMID: 28365784 DOI: 10.1007/s00261-017-1119-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To examine the characteristic features of hepatic epithelioid hemangioendothelioma (HEH) on magnetic resonance imaging (MRI) using Gd-EOB-DTPA. MATERIAL AND METHODS Twelve patients (mean age, 50 years; male:female = 6:6) who were pathologically confirmed to have HEH in two tertiary institutions were retrospectively investigated. For qualitative analysis, the MRI features of HEH including core pattern were characterized, and lesions were divided into core and non-core groups. For quantitative analysis, standardized mean signal intensities (SIst) measured at the tumor center, periphery, and liver parenchyma were plotted against the dynamic phases. Differences in SIst between the core and non-core group were calculated for the tumor center and periphery. We also examined the radiologic and pathologic correlation for cases in which surgical resection was performed. RESULTS Forty-seven nodules in 12 patients were analyzed. The mean size of the lesions was 2.9 ± 1.0 cm. In the per-lesion analysis, ring-like arterial enhancement (74%) on arterial phase was the most frequent feature, followed by core pattern (51%), and hyperintense rim on T1-weighted imaging (43%). In the per-patient analysis, capsular retraction (75%) was the most common sign. The percentage of patients with core pattern was 58%. In the core group, the SIst of the center showed slow enhancement starting from the transitional phase, resulting in divergence between the two graphs throughout the entire dynamic study (p < 0.05). Pathologically, the lesion center consisted of reduced cellularity with myxohyaline stroma and necrosis. CONCLUSION Core pattern can be considered a new diagnostic sign of HEH.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Sang Yun Ha
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Won Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Nakamura D, Adachi Y, Nakashima Y, Sakaida N, Narahara H, Shi M, Tsubono M, Ikehara S. Hepatic epithelioid hemangioendothelioma with metastasis to the mesentery of the small intestine: A case report. Mol Clin Oncol 2017; 7:815-819. [PMID: 29142751 PMCID: PMC5666655 DOI: 10.3892/mco.2017.1402] [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] [Received: 03/09/2017] [Accepted: 06/28/2017] [Indexed: 01/09/2023] Open
Abstract
Epithelioid hemangioendothelioma (EHAE) is a vascular tumor which, due to its rarity, is often misdiagnosed as other hepatic tumors based on radiological characteristics. We herein report a case of EHAE in the liver and the mesentery of the small intestine. A 64-year-old asymptomatic woman was admitted to the hospital due to a hepatic tumor identified using computed tomography (CT). An enhanced CT scan revealed multiple tumors in the liver and a tumor in the mesentery. One of the hepatic tumors and the mesenteric tumor were resected and histologically examined. The two tumors exhibited similar histological characteristics and were diagnosed as EHAE. When multiple tumors are found in the liver, EHAE should be included in the differential diagnosis, as the prognosis of EHAE differs from that of carcinoma or benign tumors.
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Affiliation(s)
- Daichi Nakamura
- Department of Surgery, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Yasushi Adachi
- Department of Diagnostic Pathology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Yasuaki Nakashima
- Department of Pathology and Cytology Center, BML Group PCL Japan, Ibaraki, Osaka 567-0865, Japan
| | - Noriko Sakaida
- Department of Pathology and Cytology Center, BML Group PCL Japan, Ibaraki, Osaka 567-0865, Japan.,Department of Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8586, Japan.,Department of Diagnostic Pathology, Kakogawa Central Hospital, Kakogawa, Hyogo 675-8611, Japan
| | - Hiroyuki Narahara
- Department of Medical Oncology, Nishinomiya Hospital, Nishinomiya, Hyogo 662-0918, Japan
| | - Ming Shi
- School of Public Health, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Michihiko Tsubono
- Department of Surgery, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Susumu Ikehara
- Emeritus Professor, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
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18
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Guo Q, Xue J, Xu L, Shi Z, Zhou B. The clinical features of epithelioid hemangioendothelioma in a Han Chinese population: A retrospective analysis. Medicine (Baltimore) 2017; 96:e7345. [PMID: 28658152 PMCID: PMC5500074 DOI: 10.1097/md.0000000000007345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare indolent vascular tumor which occurs at liver, lung, bone, and so on. However, the etiology of EHE is evasive.These patients were enrolled at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2015. Retrospective analysis is done by demographic data of clinical manifestations, laboratory parameters, CT imaging, histological, and immunohistochemical features in 9 cases in Shaanxi.Of the patients, 8 were females (88.9%) and 1 were males (11.1%). The age ranged from 34 to 71 years (mean 49 years; median 49 years). Anatomical sites of primary lesions were as follows: liver (n = 6, 66.7%), upper extremities (n = 1, 11.1%), sublingual gland (n = 1, 11.1%), and spine (n = 1, 11.1%). Metastatic disease was diagnosed in 5 cases (55.6%) with occurrence in lung (n = 4, 44.4%), bone (n = 2, 22.2%), upper extremities (n = 1, 11.1%), pleura (n = 1, 11.1%), and spleen (n = 1, 11.1%). Tumor size ranged from 0.5 to 6.8 cm (mean 3 cm). The most tumors were composed of highly cellular areas with small and prominent nucleoli in vesicular nuclei, and ERG (100%) was the most frequently positive in these cases, followed by CD31 (88.9%) and CD34 (77.8%) via histology and immunohistochemistry techniques.EHE is a very rare in Shaanxi. It is significant to find its clinical, radiological, and pathological characters, helping for EHE early diagnosis and treatment, reducing misdiagnosis and improving life quality.
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Affiliation(s)
| | - Jing Xue
- Department of Respiratory, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Lin Xu
- Department of Endocrinology, the Affiliated Guangren Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Zhihong Shi
- Department of Respiratory, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Bo Zhou
- Department of Respiratory, the First Affiliated Hospital of Xi’an Jiaotong University
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19
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Abstract
Hemangioendothelioma is a vascular tumor of endothelial nature of intermediate grade. It most commonly arises from soft tissue of upper and lower extremities. We report a rare case of epithelioid hemangioendothelioma of the urinary bladder. Histologically, it was a vascular tumor formed by smaller capillaries lined by plump epithelioid cells having eosinophilic cytoplasm. Diagnosis was confirmed by immunohistochemistry, as the tumor cells were positive for CD34 and smooth muscle actin.
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Affiliation(s)
- Sumanta Bhattacharya
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Indranil Das
- Department of Pathology, Nil Ratan Sarkar Medical College and Hospital, Kolkata, West Bengal, India
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20
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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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21
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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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22
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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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23
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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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24
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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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25
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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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26
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Da Ines D, Mons A, Braidy C, Montoriol PF, Garcier JM, Vilgrain V. Hepatic capsular retraction: spectrum of diagnosis at MRI. Acta Radiol Short Rep 2014; 3:2047981614545667. [PMID: 25535571 PMCID: PMC4271716 DOI: 10.1177/2047981614545667] [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: 03/06/2014] [Accepted: 07/08/2014] [Indexed: 11/22/2022] Open
Abstract
Hepatic capsular retraction is an imaging feature that deserves the attention of the radiologist. Hepatic capsular retraction is associated with a number of hepatic lesions, benign or malignant, treated or untreated. The purpose of this pictorial review is to discuss the most common benign and malignant hepatic lesions associated with this feature with an emphasis on magnetic resonance imaging (MRI).
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Affiliation(s)
- David Da Ines
- CHU Clermont-Ferrand, CHU Estaing, Department of Radiology and Medical Imaging, Clermont-Ferrand, France
| | - Antoine Mons
- CHU Clermont-Ferrand, CHU Estaing, Department of Radiology and Medical Imaging, Clermont-Ferrand, France
| | - Chadi Braidy
- CHU Clermont-Ferrand, CHU Estaing, Department of Radiology and Medical Imaging, Clermont-Ferrand, France
| | - Pierre François Montoriol
- CHU Clermont-Ferrand, CHU Estaing, Department of Radiology and Medical Imaging, Clermont-Ferrand, France
| | - Jean-Marc Garcier
- CHU Clermont-Ferrand, CHU Estaing, Department of Radiology and Medical Imaging, Clermont-Ferrand, France
| | - Valérie Vilgrain
- Assistance-Publique Hôpitaux de Paris, APHP, Hôpital Beaujon, Department of Radiology, Clichy, France ; Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de Recherche Biomédicale Bichat Beaujon, Paris, France
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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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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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Thomas RM, Aloia TA, Truty MJ, Tseng WH, Choi EA, Curley SA, Vauthey JN, Abdalla EK. Treatment sequencing strategy for hepatic epithelioid haemangioendothelioma. HPB (Oxford) 2014; 16:677-85. [PMID: 24308564 PMCID: PMC4105907 DOI: 10.1111/hpb.12202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/30/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The biology of hepatic epithelial haemangioendothelioma (HEHE) is variable, lying intermediate to haemangioma and angiosarcoma. Treatments vary owing to the rarity of the disease and frequent misdiagnosis. METHODS Between 1989 and 2013, patients retrospectively identified with HEHE from a single academic cancer centre were analysed to evaluate clinicopathological factors and initial treatment regimens associated with survival. RESULTS Fifty patients with confirmed HEHE had a median follow-up of 51 months (range 1-322). There was no difference in 5-year survival between patients presenting with unilateral compared with bilateral hepatic disease (51.4% versus 80.7%, respectively; P = 0.1), localized compared with metastatic disease (69% versus 78.3%, respectively; P = 0.7) or an initial treatment regimen of Surgery, Chemotherapy/Embolization or Observation alone (83.3% versus 71.3% versus 72.4%, respectively; P = 0.9). However, 5-year survival for patients treated with chemotherapy at any point during their disease course was decreased compared with those who did not receive any chemotherapy (43.6% versus 82.9%, respectively; P = 0.02) and was predictive of a decreased overall survival on univariate analysis [HR 3.1 (CI 0.9-10.7), P = 0.02]. CONCLUSIONS HEHE frequently follows an indolent course, suggesting that immediate treatment may not be the optimal strategy. Initial observation to assess disease behaviour may better stratify treatment options, reserving surgery for those who remain resectable/transplantable. Prospective cooperative trials or registries may confirm this strategy.
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Affiliation(s)
- Ryan M Thomas
- Department of Surgery, NF/SG VA Medical CenterGainesville, FL, USA,Department of Surgery, University of Florida College of MedicineGainesville, FL, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Mark J Truty
- Department of Surgery, Division of Gastrointestinal and General Surgery, Mayo Clinic College of MedicineRochester, MN, USA
| | - Warren H Tseng
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Eugene A Choi
- Department of Surgery, Sections of General Surgery and Surgical Oncology, University of Chicago HospitalsChicago, IL, USA
| | - Steven A Curley
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Jean N Vauthey
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Eddie K Abdalla
- Department of Surgery, Division of Surgical Oncology, Lebanese American UniversityBeirut, Lebanon
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Affiliation(s)
- Keum Ha Choi
- Department of Pathology, Wonkwang University College of Medicine, Iksan, Korea
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31
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Palma AF, Oberkofler CE, Raptis DA, Eshmuminov D, de Rougemont O, Schnyder A, Dimitroulis D, Lesurtel M, Dutkowski P, Clavien PA. Novel rescue procedure for inferior vena cava reconstruction in living-donor liver transplantation using a vascular graft recovered 25 h after donors' circulatory death and systematic review. Transpl Int 2013; 27:204-10. [PMID: 24289717 DOI: 10.1111/tri.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/15/2013] [Accepted: 11/01/2013] [Indexed: 12/20/2022]
Abstract
Liver transplantation is a lifesaving treatment for patients suffering from end-stage liver disease. Rarely, acute congestion of the inferior vena cava (IVC) is being encountered because of tumor compression. MELD allocation does not reflect severity of this condition because of lack of organ failure. Herein, a patient is being presented undergoing urgent living-donor liver transplantation (LDLT) with IVC reconstruction for a fast-growing hepatic epithelioid hemangioendothelioma (HEH). IVC reconstruction using a venous graft recovered from a 25-h after circulatory-death prior transplantation became necessary to compensate severe venous congestion. Additionally, a systematic review of the literature searching MEDLINE/PubMed was performed. Protocol and eligibility criteria were specified in advance and registered at the PROSPERO registry (CRD42013004827). Published literature of IVC reconstruction in LDLT was selected. Two reports describing IVC reconstruction with cryopreserved IVC grafts and one IVC reconstruction using a deceased after-circulatory-death-donor IVC graft were included. Follow-up was at 12 and 13 months, respectively. Regarding the graft recovery in the setting of living-related donation, this graft remained patent during the nine-month follow-up period. This is the first report on the use of a venous graft from a circulatory-death-donor, not eligible for whole organ recovery. We demonstrate in this study the feasibility of using a size and blood-group-compatible IVC graft from a cold-stored donor, which can solve the problem of urgent IVC reconstruction in patients undergoing LDLT.
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Affiliation(s)
- Adrian F Palma
- Department of Surgery, Swiss HPB and Transplant Center, University Hospital Zürich, Zürich, Switzerland
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Zis P, Assi A, Kravaritis D, Sevastianos VA. Ischemic stroke as the first manifestation of hepatic epithelioid hemangioendothelioma. J Stroke Cerebrovasc Dis 2013; 23:e237-40. [PMID: 24231139 DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022] Open
Abstract
A 38-year-old obese woman, with a past medical history of cholecystectomy and dyslipidaemia, presented with acute occipital headache, vomiting and rotational vertigo which lasted 8 hours. On admission neurological examination was unremarkable, however general physical examination revealed hepatomegaly. Routine blood tests showed abnormal liver function tests. MRI scan indicated an acute ischemic infarct in the right cerebellum. Extensive investigation was negative. However, liver MRI revealed multiple lesions in both liver lobes. Ultrasound guided liver biopsy and histopathological analysis confirmed the diagnosis of hepatic hemangioendothelioma. In conclusion, hypercoaguable state related to hepatic epithelioid hemangioendothelioma can lead to an ischemic stroke, as a rare first manifestation of the disease.
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Affiliation(s)
- Panagiotis Zis
- Department of Neurology, Evangelismos General Hospital, Athens, Greece.
| | - Avraam Assi
- Fourth Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
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Kamath SM, Nagaraj HK, Mysorekar VV. Hepatic and adrenal hemangioendothelioma-a case report. J Clin Diagn Res 2013; 7:2583-4. [PMID: 24392409 DOI: 10.7860/jcdr/2013/6808.3620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023]
Abstract
Haemangioendothelioma (HE) liver is a mesenchymal vascular tumour, intermediate between a haemangioma and an angiosarcoma. It has a variable clinical course, is a low grade malignancy and is associated with long-term survival. It has a characteristic histologic appearance. Immunohistochemical studies have shown that the neoplastic cells in HE are of endothelial derivation. These are essential to distinguish HE from metastatic carcinoma and primary epithelial liver tumour. We report a case of a 36-year-old male with HE of the liver with adrenal involvement, probably metastatic, with tuberculosis as an incidental finding. To our knowledge this is the first such case reported in literature. The confirmation of diagnosis was done by immunohistochemical study.
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Affiliation(s)
- Sulata M Kamath
- Professor, Department of Pathology, M S Ramaiah Medical College and Hospitals , M.S.R Nagar, M.S.R.I.T post, Bangalore - 560054, India
| | - H K Nagaraj
- Professor & HOD, Department of Urology, M S Ramaiah Medical College and Hospitals , M.S.R Nagar, M.S.R.I.T Post, Bangalore - 560054, India
| | - Vijaya V Mysorekar
- Professor & HOD, Department of Urology, M S Ramaiah Medical College and Hospitals , M.S.R Nagar, M.S.R.I.T Post, Bangalore - 560054, India
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Fan F, Yang X, Zhu B, Zhang Y. Clinical and radiological characteristics of Chinese patients with hepatic epithelioid hemangioendothelioma. Ann Saudi Med 2013; 33:334-8. [PMID: 24060710 PMCID: PMC6078508 DOI: 10.5144/0256-4947.2013.334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To study clinical features, imaging findings, and prognosis of hepatic epithelioid hemangioendothelioma (HEHE) in Eastern Hepatobiliary Surgical Hospital and to improve the level of recognition and preoperative diagnosis of HEHE. DESIGN AND SETTINGS This is a retrospective study. The study was conducted at Eastern Hepatobiliary Surgical Hospital in Shanghai, China from 1999 to 2012. METHODS Clinical data of 15 pathology-confirmed HEHE patients admitted in our hospital from 1999-2010 were collected and analyzed retrospectively. RESULTS Besides 7 cases of abdominal discomfort, this cohort of HEHE patients does not show common typical manifestations. Laboratory examinations found 8 low ALB/GLB cases, 3 mild anemia cases, and 1 high alanine aminotransferase case, but no abnormal a-fetoprotein, carcinoembryonic antigen, or CA19-9 cases. Plain computed tomography (CT) scanning found uneven multiple low-density lesions in most cases, dynamic enhanced CT scanning demonstrated peripheral enhancement in the hepatic arterial HA phase and more peripheral enhancement in the portal vein PV phase, and ring enhancement were detected in the delayed phase. Magnetic resonance imaging (MRI) demonstrated low signal intensity and even lower lesion centers in T1-weighted im.ages, but slightly high signal intensity lesions and higher lesion centers in T2-weighted images. Enhanced MRI scanning showed ring enhancements but no obvious enhanced centers. Lesions were further enhanced in delayed MRI scanning. Prognosis of this cohort: 10 of these 15 patients were alive, including 4 cases with a tumor. CONCLUSION Comprehending the clinical and radiological characteristics of HEHE facilitates the level of recognition and preoperative diagnosis of this disease, and promotes surgeons to take active and appropriate surgeries.
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Affiliation(s)
- Fei Fan
- Dr. Bin Zhu, Department of Biliary Surgery II,, Eastern Hepatobiliary Surgical Hospital,, Second Military Medical University,, Shanghai 200438, China, T:+862165564166, F:+862165562400,
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Mistry AM, Gorden DL, Busler JF, Coogan AC, Kelly BS. Diagnostic and therapeutic challenges in hepatic epithelioid hemangioendothelioma. J Gastrointest Cancer 2013; 43:521-5. [PMID: 22544493 DOI: 10.1007/s12029-012-9389-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Epithelioid hemangioendothelioma is a very rare, low-grade vascular tumor known to arise in soft tissues and visceral organs. Clinical diagnosis of hepatic epithelioid hemangioendothelioma remains a challenge, and although it is frequently managed with a liver transplant due to its multifocal nature, recurrence is a common complication. METHODS We review recent advances in the diagnosis of hepatic epithelioid hemangioendothelioma, including major genetic breakthroughs, and discuss efforts to reduce post-liver transplant recurrence of hepatic epithelioid hemangioendothelioma.
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Affiliation(s)
- Akshitkumar M Mistry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-0275, USA.
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36
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Clinical experience with primary hepatic epithelioid hemangioendothelioma: retrospective study of 33 patients. World J Surg 2013; 36:2677-83. [PMID: 22890877 DOI: 10.1007/s00268-012-1714-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND This multicenter-based retrospective study aimed to investigate the prognostic factors and report our experiences with the diagnosis and treatment of hepatic epithelioid hemangioendothelioma (HEHE), a rare malignant vascular tumor. METHODS A total of 33 patients with HEHE from two centers between 2004 and 2011 were retrospectively reviewed with respect to their clinical, radiologic, and pathologic characteristics; treatment modalities and outcomes; and potential prognostic factors. RESULTS A total of 17 patients underwent liver resections (LRs) alone, 12 patients had transcatheter arterial chemoembolization (TACE) alone, three patients had LR followed by TACE, and one patient underwent liver transplantation (LT). The difference of overall survival (OS) between LR and TACE was not significant (p = 0.499). Older patients [≥47 years, n = 17; p = 0.035, hazard ratio (HR) = 7.0), those with symptoms (n = 17; p = 0.001, HR = 86.5], and those with an elevated serum CA19-9 level (>37 U/ml, n = 5; p = 0.018, HR = 5.0) had a poorer OS, according to univariate analysis. The presence of symptoms was validated as a prognostic factor (p = 0.012) by multivariate analysis. CONCLUSIONS Liver resection and TACE have comparable outcomes in HEHE patients. The presence of symptoms indicates a poor prognosis. Older age and elevated serum CA19-9 are potential negative impact factors on outcome.
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Hepatic epithelioid hemangioendothelioma and the danger of misdiagnosis: report of a case. Case Rep Oncol Med 2013; 2013:243939. [PMID: 23533870 PMCID: PMC3600255 DOI: 10.1155/2013/243939] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/01/2013] [Indexed: 02/07/2023] Open
Abstract
Malignant hepatic epithelioid hemangioendothelioma (HEHE) is a rare malignant tumor of vascular origin. Nonspecific symptoms and the absence of experience of surgeons, radiologists, and histopathologists due to the rarity of HEHE make the diagnosis of this entity very challenging. Misdiagnosis is not a rare event, and the consequences of such an event are catastrophic. We report a case of a patient suffering from HEHE in which the initial diagnosis was hepatocellular carcinoma (HCC). The presence of normal laboratory values, liver function tests, tumor markers along with the absence of a chronic liver disease, or any other predisposing factors for HCC, was in contrast with the diagnosis of HCC. Clinical suspicion drove us to the repetition of a liver biopsy and the reevaluation of the sample by a more experience histopathology department in liver tumors. The last biopsy confirmed the diagnosis of HEHE, and the patient escaped any unnecessary treatment for a nonexisting HCC.
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38
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Jurczyk M, Zhu B, Laskin W, Lin X. Pitfalls in the diagnosis of hepatic epithelioid hemangioendothelioma by FNA and needle core biopsy. Diagn Cytopathol 2013; 42:516-20. [PMID: 23288560 DOI: 10.1002/dc.22943] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 11/20/2012] [Indexed: 11/08/2022]
Abstract
Epithelioid hemangioendothelioma (EHE) of the liver is an extremely rare tumor that masquerades as an epithelial neoplasm and poses significant diagnostic pitfalls for the cytopathologist. This report describes a 64-year-old woman whom on computerized tomography was found to have multiple peripherally calcified hypodense lesions throughout the liver and an ipsilateral adrenal mass. Fine needle aspiration and needle cores biopsies of the largest liver lesion showed epithelioid cells and spindle cells in fibrous stroma. The epithelioid cells had round or oval, hyperchromatic nuclei with smooth nuclear contours, delicate cytoplasm and indistinct cytoplasmic borders. Rare cells had intracellular vascular lumen containing fragmented or intact red blood cells. The cells were individually dispersed or arranged in nests and vague tubular arrays. No mitotic figures or necrosis were seen. An immunohistochemical profile demonstrated diffuse CD31 and focal CD 34 and nuclear Fli-1 immunoexpression and low Ki-67 proliferative activity (1%) within lesional cells confirming the diagnosis of EHE. The differential diagnosis of EHE which includes cholangiocarcinoma, hepatocellular carcinoma, metastatic carcinoma and melanoma is discussed.
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Affiliation(s)
- Matthew Jurczyk
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois
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39
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Sangro B, Iñarrairaegui M, Fernández-Ros N. Malignant epithelioid hemangioendothelioma of the liver successfully treated with Sorafenib. Rare Tumors 2012; 4:e34. [PMID: 22826791 PMCID: PMC3401162 DOI: 10.4081/rt.2012.e34] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/27/2012] [Accepted: 03/28/2012] [Indexed: 02/07/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEH) is a rare disease of unknown etiology for which a standard systemic treatment has not been established. The common expression of vascular endothelial growth factor (VEGF) and its receptor in HEH provide a rationale for the reported use of antiangiogenic drugs, including bevacizumab, lenalidomide and thalidomide. We report a case of a young male patient with HEH who was treated with sorafenib for almost 2 years. Sorafenib was used instead of other VEGF inhibitors due to its convenient oral route, its dual antiangiogenic and antiproliferative activity, and its favorable safety profile. Sorafenib therapy resulted in durable stabilization with progressive calcification of liver tumors and minor but stable response of lung lesions.
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40
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Agrawal N, Parajuli S, Zhao P, Satoskar R, Laurin J, Azumi N, Matsumoto C, Shetty K. Liver transplantation in the management of hepatic epithelioid hemangioendothelioma: a single-center experience and review of the literature. Transplant Proc 2012; 43:2647-50. [PMID: 21911139 DOI: 10.1016/j.transproceed.2011.06.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/03/2011] [Indexed: 12/12/2022]
Abstract
Hepatic epitheliod hemangioendothelioma (HEHE) is a rare tumor of vascular origin with unpredictable malignant potential. We describe our experience with four biopsy-proven HEHE cases that were considered for orthotopic liver transplant (OLT). Three patients had preserved hepatic function and despite extensive disease burden did not develop disease progression while awaiting OLT. We were able to utilize the review process allowed by United Network of Organ Sharing to obtain additional priority for OLT for these patients. This led to expedited organ allocation and excellent post-OLT outcomes.
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Affiliation(s)
- N Agrawal
- Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC 20007, USA
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41
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Amin S, Chung H, Jha R. Hepatic epithelioid hemangioendothelioma: MR imaging findings. ACTA ACUST UNITED AC 2011; 36:407-14. [PMID: 21079951 DOI: 10.1007/s00261-010-9662-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report the MRI findings in three patients with pathologically proven hepatic epithelioid hemangioendothelioma, a rare tumor of the liver that is not well described in the MR imaging literature. The recognition of the imaging features of this rare malignancy may help further early detection and surgical treatment of this potentially curable disease.
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Affiliation(s)
- Sejal Amin
- Department of Radiology, Georgetown University Hospital, Washington, DC, USA
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Francoz C, Belghiti J, Castaing D, Chazouillères O, Duclos-Vallée JC, Duvoux C, Lerut J, Le Treut YP, Moreau R, Mandot A, Pageaux G, Samuel D, Thabut D, Valla D, Durand F. Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system. Liver Transpl 2011; 17:1137-51. [PMID: 21695771 DOI: 10.1002/lt.22363] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Model for End-Stage Liver Disease (MELD) score-based allocation systems have been adopted by most countries in Europe and North America. Indeed, the MELD score is a robust marker of early mortality for patients with cirrhosis. Except for extreme values, high pretransplant MELD scores do not significantly affect posttransplant survival. The MELD score can be used to optimize the allocation of allografts according to a sickest first policy. Most often, patients with small hepatocellular carcinomas (HCCs) and low MELD scores receive extra points, which allow them appropriate access to transplantation comparable to the access of patients with advanced cirrhosis and high MELD scores. In addition to patients with advanced cirrhosis and HCC, patients with a number of relatively uncommon conditions have low MELD scores and a poor prognosis in the short term without transplantation but derive excellent benefits from transplantation. These conditions, which correspond to the so-called MELD score exceptions, justify the allocation of a specific score for appropriate access to transplantation. Here we report the conclusions of the French consensus meeting. The goals of this meeting were (1) to identify which conditions merit MELD score exceptions, (2) to list the criteria needed for defining each of these conditions, and (3) to define a reasonable time interval for organ allocation for each MELD exception in the general context of organ shortages. MELD exceptions were discussed in an attempt to reconcile the concepts of transparency, equity, justice, and utility.
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Affiliation(s)
- Claire Francoz
- Departments of Hepatology, Beaujon Hospital, Clichy, France.
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Thin LWY, Wong DD, De Boer BW, Ferguson JM, Adams L, Macquillan G, Delriviere L, Mitchell A, Jeffrey GP. Hepatic epithelioid haemangioendothelioma: challenges in diagnosis and management. Intern Med J 2011; 40:710-5. [PMID: 19712200 DOI: 10.1111/j.1445-5994.2009.02043.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hepatic epithelioid haemangioendothelioma (HEH) is a rare, low grade malignant neoplasm of endothelial origin which is difficult to diagnose and has a variable outcome. We review five HEH cases from our centre with the aim of identifying clinical predictors of outcome and various therapeutic options. METHODS A search was made on the WA Liver Transplant registry for cases with histologically confirmed HEH. Their medical records were reviewed. A literature search was conducted through Medline using terms to compare the results from this series with those of other series. RESULTS Five patients were identified to have HEH. The mean age was 44.2years (range 34-53years). Four of five patients presented with dyspepsia and two patients had clinical evidence of portal hypertension with ascites. Two patients had radiologically diffuse disease and three patients had discrete nodular liver involvement. The mean duration from presentation of symptoms to diagnosis of HEH was 26.8months. Liver transplantation was performed in one patient with diffuse HEH who is alive with no disease recurrence at 3years. Three patients with radiologically stable disease followed with 6monthly surveillance imaging are currently alive and well. The median survival of all five patients was 5years (range 1.5-16years) at the time of follow up. CONCLUSIONS These results support the role of surveillance alone for patients with focal and radiologically stable disease. Patients with diffuse HEH with hepatic decompensation should be considered for transplantation. However, numbers are small and an international registry is required to make firm comparisons.
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Affiliation(s)
- L W Y Thin
- WA Liver Transplant Service, PathWest Laboratory Medicine and Radiology Department, Sir Charles Gairdner Hospital, and School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.
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Harada JI, Yoshida H, Ueda J, Mamada Y, Taniai N, Mineta S, Yoshioka M, Kawano Y, Shioda Y, Uchida E. Malignant hepatic epithelioid hemangioendothelioma with abdominal pain due to rapid progression. J NIPPON MED SCH 2011; 78:246-51. [PMID: 21869559 DOI: 10.1272/jnms.78.246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor. We report on a patient who underwent hepatectomy for malignant HEH associated with abdominal pain due to rapid progression. An 83-year-old man was admitted to Nippon Medical School Hospital because of acute, severe upper abdominal pain. Seven months before admission, a hepatic tumor, 3 cm in diameter, had been detected in the left lateral sector. The diagnosis was hepatic cavernous hemangioma. Abdominal ultrasonography revealed a heterogeneous hyperechoic tumor with a smooth border, 6 cm in diameter, in the left lateral sector (segment 3). Contrast-enhanced computed tomography of the abdomen showed that the tumor was enhanced from the early to the late phase. Abdominal angiography revealed a cotton wool-like appearance of the tumor. The diagnosis was hepatic cavernous hemangioma. A malignancy could not be ruled out because of the tumor's rapid growth, which had caused abdominal pain. Left hepatectomy was performed. Histopathological examination showed necrosis throughout the tumor. Slightly pleomorphic neoplastic cells with rounded, spindle-like nuclei and scant cytoplasm were sporadically found in vascular channels. Intracytoplasmic lumina occasionally contained red cells. Neoplastic cells were positive for factor VIII-related antigen, CD31, and CD34. The Mib-1 index was high. The tumor was diagnosed as malignant HEH. The postsurgical course was uneventful, and the patient was discharged on postoperative day 11. After 3 months, multiple metastatic tumors appeared in right hepatic lobe. Transcatheter arterial chemoembolization was performed.
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Affiliation(s)
- Jun-Ichiro Harada
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan.
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Verma SK, Mitchell DG, Bergin D. Case report: MRI diagnosis of multifocal epithelioid hemangioendothelioma of the liver. Indian J Radiol Imaging 2011; 18:239-41. [PMID: 19774167 PMCID: PMC2747429 DOI: 10.4103/0971-3026.41837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sachit K Verma
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia 19107, USA
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Liu YI, Brown SS, Elihu A, Bonham CA, Concepcion W, Longacre TA, Kamaya A. Hepatic epithelioid hemangioendothelioma. Dig Dis Sci 2011; 56:303-6. [PMID: 21053076 DOI: 10.1007/s10620-010-1470-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 10/15/2010] [Indexed: 12/11/2022]
Affiliation(s)
- Yueyi I Liu
- Department of Radiology, Stanford University Medical Center, Stanford, CA 94305, USA
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Grossman EJ, Millis JM. Liver transplantation for non-hepatocellular carcinoma malignancy: Indications, limitations, and analysis of the current literature. Liver Transpl 2010; 16:930-42. [PMID: 20677284 DOI: 10.1002/lt.22106] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Orthotopic liver transplantation (OLT) is currently incorporated into the treatment regimens for specific nonhepatocellular malignancies. For patients suffering from early-stage, unresectable hilar cholangiocarcinoma (CCA), OLT preceded by neoadjuvant radiotherapy has the potential to readily achieve a tumor-free margin, accomplish a radical resection, and treat underlying primary sclerosing cholangitis when present. In highly selected stage I and II patients with CCA, the 5-year survival rate is 80%. As additional data are accrued, OLT with neoadjuvant chemoradiation may become a viable alternative to resection for patients with localized, node-negative hilar CCA. Hepatic involvement from neuroendocrine tumors can be treated with OLT when metastases are unresectable or for palliation of medically uncontrollable symptoms. Five-year survival rates as high as 90% have been reported, and the Ki67 labeling index can be used to predict outcomes after OLT. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin. The data from single-institution series are limited, but compiled reviews have reported 1- and 10-year survival rates of 96% and 72%, respectively. Hepatoblastoma is the most common primary hepatic malignancy in children. There exist subtle differences in the timing of chemotherapy between US and European centers; however, the long-term survival rate after transplantation ranges from 66% to 77%. Fibrolamellar hepatocellular carcinoma is a distinct liver malignancy best treated by surgical resection. However, there is an increasing amount of data supporting OLT when resection is contraindicated. In the treatment of either primary or metastatic hepatic sarcomas, unacceptable survival and recurrence rates currently prohibit the use of OLT.
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Affiliation(s)
- Eric J Grossman
- Section of Transplantation, Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
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48
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Epithelioid hemangioendothelioma of the liver with metastatic coeliac lymph nodes in an 11-year-old boy. Pediatr Radiol 2010; 40:1293-6. [PMID: 20112013 DOI: 10.1007/s00247-009-1532-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/23/2009] [Accepted: 11/23/2009] [Indexed: 10/19/2022]
Abstract
Epithelioid hemangioendothelioma of the liver is a very rare vascular tumour in children with intermediate malignant potential. We present a case in which the typical imaging appearances of coalescent peripheral hepatic masses with capsular retraction contributed to the diagnosis. A positron emission tomography-CT (PET-CT) procedure was performed in staging the disease with a strong suspicion of coeliac nodal involvement confirmed after laparotomy and histological analysis. Our case is unique because of the rarity of the disease, the young age of the child, and proven nodal metastases at initial diagnosis. The use of PET-CT allows better staging at initial diagnosis and thus better management with improved follow-up in these patients.
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Kim GH, Kim YS, Kim HO, Kim KH, Hung YK, Jung DH, Kim JH, Kwon OS, Choi DJ, Kim JH. [A case of primary hepatic epithelioid hemangioendothelioma with spontaneous rupture]. THE KOREAN JOURNAL OF HEPATOLOGY 2010; 15:510-6. [PMID: 20037270 DOI: 10.3350/kjhep.2009.15.4.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Primary hepatic epithelioid hemangioendothelioma is a rare neoplasm of endothelial origin. The clinical manifestations are nonspecific, ranging from complete absence of symptoms to hepatic failure and death. Spontaneous rupture of a hepatic epithelioid hemangioendothelioma is an extremely rare presentation. We present a case of primary hepatic epithelioid hemangioendothelioma in a 65-year-old male patient with alcoholic liver cirrhosis. He was hospitalized due to epigastric pain and multiple liver masses on abdominal ultrasound. Dynamic liver CT imaging revealed multiple peripheral nodular enhanced mass lesions with delayed centripetal enhancement, and the adjacent collection of high-attenuation fluid along the liver capsule. Abdominal tapping revealed blood in the peritoneal cavity. Primary hepatic epithelioid hemangioendothelioma with spontaneous rupture was finally diagnosed based on a histopathologic examination revealing positive immunohistochemical staining for CD34.
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Affiliation(s)
- Geum Ha Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
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Chang JY, Marks RS, Nagorney DM, Sanderson SO, Kane S. Ulcerative colitis, infliximab, and hepatic epithelioid hemangioendothelioma: who is to blame? Case Report. Therap Adv Gastroenterol 2010; 3:203-6. [PMID: 21180602 PMCID: PMC3002576 DOI: 10.1177/1756283x10363015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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