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Finney N, Tran T, Hasjim BJ, Jakowatz J, Chiao E, Eng O, Wolf R, Jutric Z, Yamamoto M, Tran TB. Primary sarcoma of the liver: A nationwide analysis of a rare mesenchymal tumor. J Surg Oncol 2024; 129:358-364. [PMID: 37796036 DOI: 10.1002/jso.27477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/10/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary liver sarcomas are rare malignancies. Prognostic factors associated with long-term survival remain poorly understood. The objective of this study is to determine factors associated with long-term survival. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with visceral sarcoma arising from the liver. Demographic factors, tumor characteristics, resection status, and survival were evaluated. Multivariate Cox regression analysis was performed to determine predictors of survival. RESULTS A total of 743 patients with primary hepatic sarcoma were identified. The median tumor size was 10 cm. Only 30% (n = 221) of patients in the cohort underwent surgery. The 5-year overall survival rates were 47.9% for localized disease, 29.5% for regional disease, and 16.5% for distant disease, p < 0.001. Among patients who underwent surgical resection, patients with embryonal sarcoma had better 5-year survival compared with angiosarcoma and other histologic subtypes. On multivariate analysis, surgery was associated with improved survival, while older age, higher stage, and angiosarcoma histology were the strongest independent predictors of poor survival. CONCLUSIONS Surgery remains the mainstay of treatment for this rare malignancy but is performed in less than one-third of patients. Angiosarcoma histology is associated with worse overall survival, while surgical resection remains the strongest predictor of improved overall survival.
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Affiliation(s)
- Nicole Finney
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Tu Tran
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Bima J Hasjim
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - James Jakowatz
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Elaine Chiao
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Oliver Eng
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Ronald Wolf
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Zeljika Jutric
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Maki Yamamoto
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Thuy B Tran
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
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2
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Martins ACDEA, Costa Neto DCDA, Silva JÚDDEME, Moraes YM, LeÃo CS, Martins C. Adult primary liver sarcoma: systematic review. ACTA ACUST UNITED AC 2020; 47:e20202647. [PMID: 33263653 DOI: 10.1590/0100-6991e-20202647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/29/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION primary liver sarcoma is a rare type of tumor, more common in children. Among adults, it represents a spectrum of neoplasms with reserved prognosis. There is no consensus on the treatment of choice of these lesions, justifying a systematic review of the literature on treatment options, prognostic factors, and survival. MATERIAL/METHODS a systematic review of articles published in Pubmed, Medline, LiLacs e SciElo, from 1966 to March/2019, presenting the keywords: primary-liver-sarcoma and primary-hepatic-sarcoma was undertaken. Studies including patients older than 18 years, and published in English, Portuguese and Spanish were included. Case reports, metastatic tumors and multiple oncologic diagnosis were excluded. The initial search listed 1,318 articles. 1,206 did not meet the inclusion criteria. After reviewing 112 eligible articles, 15 were selected (14 case series and 1 retrospective-cohort). RESULTS proposed treatment modalities for primary liver sarcoma included surgery and/or chemotherapy and/or radiotherapy or liver transplantation. The most common histological types were angiosarcoma (32%), leiomyosarcoma (29%), epithelioid hemangioendothelioma (15%) and embryonal sarcoma (7%). Histology, degree of differentiation and R0 resection were mentioned positive prognostic factors. Median survival ranged from two to 23 months. Five-year survival rate varied from 0% to 64%, on average 21%. CONCLUSION surgical resection (R0 resection) is the main treatment for primary liver sarcomas. Development of effective systemic therapies are required to improve prognosis of patients harboring this type of tumor.
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Affiliation(s)
- Antonio Cavalcanti DE Albuquerque Martins
- - Instituto de Medicina Integral Prof. Fernando Figueira, Departamento de Cirurgia Geral - Recife - PE - Brasil.,- Faculdade Pernambucana de Saúde - FPS/IMIP, Curso de Medicina - Recife - PE - Brasil
| | | | | | - Ygor Monteiro Moraes
- - Faculdade Pernambucana de Saúde - FPS/IMIP, Curso de Medicina - Recife - PE - Brasil
| | - Cristiano Souza LeÃo
- - Instituto de Medicina Integral Prof. Fernando Figueira, Departamento de Cirurgia Geral - Recife - PE - Brasil.,- Faculdade Pernambucana de Saúde - FPS/IMIP, Curso de Medicina - Recife - PE - Brasil
| | - Carolina Martins
- - Hospital Metropolitano Oeste Pelópidas Silveira (HPS) - SUS-PE/IMIP, Diretoria de Ensino e Pesquisa - Recife - PE - Brasil.,- Universidade Federal de Pernambuco - UFPE, Coordenação de Pequisa - Centro de Ciências Médicas - Recife - PE - Brasil
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3
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Perilongo G, Carli M, Sainati L, Cecchetto G, Mancini A, Cordero di Montezemolo L, Comelli A, Colella R, Tamaro P, Colleselli P. Undifferentiated (Embryonal) Sarcoma of the Liver in Childhood: Results of a Retrospective Italian Study. TUMORI JOURNAL 2018; 73:213-7. [PMID: 3603715 DOI: 10.1177/030089168707300302] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical features and the treatment of undifferentiated (embryonal) sarcoma of the liver in 8 patients younger than 19 years old were analyzed. AH these cases were registered in the retrospective multicentric study on childhood malignant tumors of the liver, conducted between 1983 and 1985 by the Italian Association of Pediatric Hematology Oncology. The age of the patients ranged from 94 to 190 months (median = 113.5 months); all children were males. An abdominal mass was the common presenting features. Abnormalities in hemogram and common liver tests were rarely reported. Angiography revealed various degrees of vascularization in these tumors. Two patients achieved a surgical complete remission (CR) at diagnosis; one patient achieved surgical CR after primary chemotherapy with vincristine, adriamycin, cyclophosphamide and 5-fluorouracil, which reduced the tumor volume and permitted surgical resection. Two of these patients are still in CR at 14 and 60 months after diagnosis; the third patient died of liver failure without evidence of recurrence 6 months after diagnosis. All of the other patients, who never achieved CR, died of disease. One was lost to follow-up, and one surgical death occurred. Reports of childhood undifferentiated sarcoma are reviewed.
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4
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Undifferentiated sarcoma of the liver: a single institution experience using a uniform treatment approach. J Pediatr Hematol Oncol 2012; 34:e114-6. [PMID: 22217489 PMCID: PMC4131680 DOI: 10.1097/mph.0b013e3182331fbe] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Undifferentiated (embryonal) sarcoma of the liver is a rare malignant tumor, most commonly seen in children aged 6 to 10 years. Previously believed to carry a poor prognosis, more recent reports indicate that treatment regimens combining surgical resection and adjuvant chemotherapy can yield long-term, disease-free survival. In this study, we review 5 pediatric patients with undifferentiated sarcoma of the liver treated with a uniform approach of resection followed by adjuvant chemotherapy and radiation when indicated. All 5 patients are disease free in their first remission at a median of 53 months.
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5
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Lee JA, Kim TW, Min JH, Byon SJ, Jang SH, Choi SY, Kim HJ. [A case of undifferentiated (embryonal) liver sarcoma mimicking klatskin tumor in an adult]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 55:144-8. [PMID: 20168062 DOI: 10.4166/kjg.2010.55.2.144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Undifferentiated sarcoma is an uncommon primary malignant tumor of the liver typically occurring in older children. It is also referred to as malignant mesenchymoma, fibromyxosarcoma, or mesenchymal sarcoma. We experienced a case of undifferentiated sarcoma in 72-year-old male. Contrast enhanced liver CT scan revealed a 3.4 cm heterogeneously enhancing, ill-defined, and low attenuated mass in the left liver and subtle intrahepatic duct dilatation. And, in tubogram, there were segmental stenosis and occlusion from the hilum to the proximal common bile duct. We did ultrasonography guided liver biopsy. The pathologic finding revealed infiltrative growth of atypical cells with rhabdoid features. Some atypical cells showed clear cytoplasm, but no organoid pattern was identified. The stroma around atypical cells was filled with eosinophilic hyaline material. These tumor cells were positive for vimentin only, and the tumor was consistent with undifferentiated sarcoma of the liver.
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Affiliation(s)
- Ji Ae Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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6
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Okajima H, Ohya Y, Lee KJ, Yamamoto H, Asonuma K, Nagaoki Y, Ohama K, Korogi M, Anan T, Hashiyama M, Endo F, Iyama K, Inomata Y. Management of undifferentiated sarcoma of the liver including living donor liver transplantation as a backup procedure. J Pediatr Surg 2009; 44:e33-8. [PMID: 19231519 DOI: 10.1016/j.jpedsurg.2008.11.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 10/13/2008] [Accepted: 11/17/2008] [Indexed: 11/15/2022]
Abstract
We present the cases of 3 children with huge undifferentiated sarcoma of the liver who were treated with surgical excision including liver transplantation as an option and adjuvant chemotherapy. All 3 patients were males aged 10, 13, and 15 years old. The size of the tumor was 10, 15, and 20 cm in diameter, respectively. The youngest patient is disease free and doing well 43 months after resection. The 13-year-old patient presented with tumor rupture and underwent operation. The primary tumor and the ruptured tissue fragments were removed and he was given postoperative chemotherapy. The patient is disease free and doing well 52 months after surgery. The oldest patient had an unresectable tumor in the hilar region. Preoperative chemotherapy was given but later discontinued owing to severe side effects. He underwent living donor liver transplantation followed by postoperative chemotherapy. The patient had recurrent tumor 24 months after transplantation that was excised at reoperation. He is doing well and is disease free 18 months after the second procedure. Complete removal of the tumor including total hepatectomy and transplantation when indicated and suitable pre- and/or postoperative chemotherapy is an effective treatment for children with undifferentiated sarcoma of the liver.
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Affiliation(s)
- Hideaki Okajima
- Department of Transplantation/Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University Hospital, Kumamoto, Japan.
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7
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Nicol K, Savell V, Moore J, Teot L, Spunt SL, Qualman S. Distinguishing undifferentiated embryonal sarcoma of the liver from biliary tract rhabdomyosarcoma: a Children's Oncology Group study. Pediatr Dev Pathol 2007; 10:89-97. [PMID: 17378682 DOI: 10.2350/06-03-0068.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Accepted: 07/25/2006] [Indexed: 01/01/2023]
Abstract
Morphologically, the distinction between undifferentiated embryonal sarcoma of the liver (UESL) and biliary tract rhabdomyosarcoma (RMS) can be uncertain because of some shared pathologic similarities. Patients with UESL have been consistently but erroneously enrolled in Children's Oncology Group (COG) treatment protocols because UESL was equated with RMS, despite the differing primary treatment modalities of these entities. Review of COG pathology files yielded 20 cases of UESL that were compared to 25 cases of biliary tract RMS. Clinicopathologic features including immunohistochemical staining were examined. In the UESL cases, the male:female ratio was 1:1 and the median age was 10.5 years. Histologically, hyaline globules and diffuse anaplasia were consistently present. The cases of RMS had a male:female ratio of 1.8:1 with a median age of 3.4 years and routinely lacked diffuse anaplasia and hyaline globules. Polyclonal desmin and muscle-specific actin were variably immunoreactive in UESL and RMS; however, myogenin and myogenic regulatory protein D1 (MyoD1) were uniformly negative in UESL and routinely positive in the majority of biliary tract RMS. Myogenin, in particular, was highly significant (P = 0.0003) in distinguishing RMS from UESL. With a median follow-up of 8 months, 11 of 18 patients with UESL were still alive. The estimated 5-year survival for biliary tract RMS was 66%. Establishing the correct diagnosis of these distinct clinical and pathologic entities is important, as surgery alone may be curative in UESL, whereas initial chemotherapy is often recommended for the treatment of biliary tract RMS.
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Affiliation(s)
- Kathleen Nicol
- Department of Pathology, Children's Hospital, Columbus, OH, USA
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8
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Affiliation(s)
- Rejin Kebudi
- Divisions of Pediatric Oncology and Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey.
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9
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Abstract
Primary angiosarcoma of the liver accounts for up to 2% of all primary liver tumors and is the second most common primary malignant neoplasm of the liver. Approximately 10 to 20 new cases are diagnosed every year in the United States and the prevalence varies from 0.14 to 0.25 per million. In an autopsy series from Chicago, one hepatic angiosarcoma was noted for every 30 cases of hepatocellular carcinoma.
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Affiliation(s)
- H Mani
- Department of Pathology, Indian Navy Health Service, Asvini, Colaba, Mumbai, India
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10
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Poggio JL, Nagorney DM, Nascimento AG, Rowland C, Kay P, Young RM, Donohue JH. Surgical treatment of adult primary hepatic sarcoma. Br J Surg 2000; 87:1500-5. [PMID: 11091236 DOI: 10.1046/j.1365-2168.2000.01564.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Primary sarcomas of the liver are extremely rare in adults. Optimal therapeutic approaches remain unclear. METHODS Twenty consecutive adult patients who had surgical treatment for primary hepatic sarcomas were reviewed. Patient age ranged from 23 to 80 years. Other than one patient with primary hepatic angiosarcoma who had a history of thorium dioxide colloid (Thorotrast) exposure 23 years before diagnosis, no predisposing causes were apparent. Nineteen patients had hepatic resection and one patient had an orthotopic liver transplant. No patient received neoadjuvant chemotherapy or radiotherapy but radiotherapy was delivered intraoperatively in one patient. RESULTS Leiomyosarcoma was the most common histological type of sarcoma diagnosed (five of 20 patients), followed by malignant solitary fibrous tumour (four) and epithelioid haemangioendothelioma (three). Fourteen tumours were high-grade sarcomas and six were low grade malignancies. Thirteen patients developed a recurrence. Distant metastases (ten patients) and intrahepatic recurrence (six) were the predominant sites of initial treatment failure. Six patients received salvage chemotherapy. Histological grade was the only factor significantly associated with overall patient survival (P= 0.03). With complete resection, patients with high-grade tumours had a 5-year survival rate of 18 (95 per cent confidence interval 5-62) per cent compared with 80 (52-100) per cent for patients with low-grade tumours. The 5-year survival rate for all 20 patients was 37 (20-60) per cent. CONCLUSION Surgical resection is the only effective therapy for primary hepatic sarcomas at present. Better adjuvant therapy is necessary, especially for high-grade malignancies, owing to the high failure rate with operation alone.
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Affiliation(s)
- J L Poggio
- Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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11
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Cho HS, Park YN, Lyu CJ, Jung WH, Park C, Kim KY. Embryonal sarcoma of the liver: multiple recurrences and histologic dedifferentiation. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 32:386-8. [PMID: 10219344 DOI: 10.1002/(sici)1096-911x(199905)32:5<386::aid-mpo15>3.0.co;2-n] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- H S Cho
- Department of Pediatrics, Hallym University College of Medicine, Seoul, Korea
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12
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Pollono DG, Drut R. Undifferentiated (embryonal) sarcoma of the liver: fine-needle aspiration cytology and preoperative chemotherapy as an approach to diagnosis and initial treatment. A case report. Diagn Cytopathol 1998; 19:102-6. [PMID: 9702485 DOI: 10.1002/(sici)1097-0339(199808)19:2<102::aid-dc6>3.0.co;2-g] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present report describes the case of a 9-year-old girl with an undifferentiated (embryonal) sarcoma of the liver diagnosed by fine-needle aspiration cytology (FNAC). The smears revealed pleomorphic cells, some with cytoplasmic vacuoles and eosinophilic inclusions, as well as spindle cells and myxoid tissue, cytologic features which appear to be distinctive from any other malignant tumor of the liver. Preoperative chemotherapy was then given using a protocol for high-grade soft-tissue sarcomas (MMT95 953 branch B, SIOP). This scheme induced very good response allowing complete surgery 8 months after diagnosis. The patient is alive and well 11 months after surgery. The combined FNAC-preoperative chemotherapy approach may prove useful for this highly malignant tumor.
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Affiliation(s)
- D G Pollono
- Unidad de Oncología, Hospital de Niños Superiora Sor María Ludovica, La Plata, Argentina
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13
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Gunawardena SW, Trautwein LM, Finegold MJ, Ogden AK. Hepatic angiosarcoma in a child: successful therapy with surgery and adjuvant chemotherapy. MEDICAL AND PEDIATRIC ONCOLOGY 1997; 28:139-43. [PMID: 8986151 DOI: 10.1002/(sici)1096-911x(199702)28:2<139::aid-mpo9>3.0.co;2-l] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a 3-year and 11-month-old Caucasian female, who initially presented with an unresectable hepatic angiosarcoma. After three courses of chemotherapy with adriamycin/cisplatin, the tumor decreased in size considerably, allowing complete surgical resection. She also received postoperative chemotherapy with alternating cycles of ifosfamide/etoposide, cisplatinum/adriamycin, and vincristine/actinomycin D/cyclophosphamide for 18 months. She remains disease-free for greater than 44 months from the initial diagnosis. Our experience suggests that total excision of the tumor, together with an aggressive chemotherapy regimen, can improve the disease-free survival for children with this highly malignant vascular tumor of the liver.
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14
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Moon WK, Kim WS, Choi BI, Kim IO, Yeon KM, Han MC. Undifferentiated embryonal sarcoma of the liver treated with chemotherapy: CT imaging in four patients. ABDOMINAL IMAGING 1995; 20:133-7. [PMID: 7787716 DOI: 10.1007/bf00201521] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The purpose of this study was to describe the computed tomography (CT) findings of undifferentiated embryonal sarcoma after chemotherapy and to correlate the CT imaging findings with pathologic findings. METHODS Ten CT images obtained before and after chemotherapy in four patients with hepatic undifferentiated embryonal sarcoma were retrospectively reviewed and correlated with pathologic findings. RESULTS After chemotherapy, tumor volume decreased by 50-90% and initially nonresectable tumor or gross residual tumor was successfully excised in three patients. In all patients, enhancing peripheral solid portions and septations changed to low-attenuation areas, and in three patients increased or de novo calcifications were found at the periphery of the tumor. Resected pathologic specimen after chemotherapy showed well-encapsulated masses with central necrosis, fibrosis, and dystrophic calcifications. CONCLUSIONS These CT findings will be useful in monitoring the treatment response of hepatic undifferentiated embryonal sarcoma during chemotherapy.
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Affiliation(s)
- W K Moon
- Department of Radiology, Seoul National University College of Medicine, Republic of Korea
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15
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Moon WK, Kim WS, Kim IO, Yeon KM, Yu IK, Choi BI, Han MC. Undifferentiated embryonal sarcoma of the liver: US and CT findings. Pediatr Radiol 1994; 24:500-3. [PMID: 7885785 DOI: 10.1007/bf02015012] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Six cases of undifferentiated embryonal sarcoma (UES) were reviewed to determine their characteristic features on ultrasonography (US) (n = 5) and computed tomography (CT) (n = 6). US demonstrated a single large, echogenic mass with some anechoic spaces. Contrast-enhanced CT scan revealed a well-demarcated low-attenuation mass with hyperdense septations of variable shape and thickness. Discrepancy of internal architecture on US and CT was one of the important characteristics of UES. CT numbers were 25-47 HU in low-attenuation areas. Enhancing peripheral rim was found in four cases and some solid portions at the periphery or adjacent to the septa were found in all cases. Two patients who had follow-up US and CT without treatment showed enhancing solid portions, changing to hypodense as the tumor grew. When compared with the pathologic findings, US showed a more accurate representation of internal architecture than did CT. Familiarity with these US and CT findings of UES of the liver will be helpful in the differential diagnosis of primary hepatic tumors in childhood.
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Affiliation(s)
- W K Moon
- Department of Radiology, Seoul National University College of Medicine, Republic of Korea
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16
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Urban CE, Mache CJ, Schwinger W, Pakisch B, Ranner G, Riccabona M, Schimpl G, Brandesky G, Messner H, Pobegen W. Undifferentiated (embryonal) sarcoma of the liver in childhood. Successful combined-modality therapy in four patients. Cancer 1993; 72:2511-6. [PMID: 8402469 DOI: 10.1002/1097-0142(19931015)72:8<2511::aid-cncr2820720833>3.0.co;2-m] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Undifferentiated (embryonal) sarcoma of the liver is a rare, highly malignant, mesenchymal tumor presenting predominantly in late childhood. Four girls, ages 6-13 years, who were treated with combined-modality regimens are reported. METHODS In the first and second patients, hemihepatectomy resulted in complete removal of the tumor, and multiple-agent chemotherapy was administered postoperatively. In the third patient, only partial resection could be accomplished initially. By synchronous radiation therapy and chemotherapy, the tumor decreased to an extent that it could be resected completely and was totally devitalized on histologic examination. Postoperative chemotherapy was discontinued after 8 weeks. In the fourth patient, the tumor was not resectable at diagnostic biopsy. Polychemotherapy led to a significant reduction of the tumor size, and resection with clear margins could be performed subsequently. Because histologic necrosis amounted to about 95%, postoperative chemotherapy was also discontinued after 6 weeks. RESULTS All four patients remain well without evidence of tumor recurrence after 79, 41, 36, and 22 months from diagnosis. CONCLUSIONS The authors suggest that a multimodal therapeutic regimen should be used in patients with undifferentiated hepatic sarcoma.
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Affiliation(s)
- C E Urban
- University Kinderklinik Graz, Division of Hematology/Oncology, Austria
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17
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Babin-Boilletot A, Flamant F, Terrier-Lacombe MJ, Marsden HB, van Unnik A, Deméocq F, Zucker JM, Voûte PA, Otten J, Behar C. Primitive malignant nonepithelial hepatic tumors in children. MEDICAL AND PEDIATRIC ONCOLOGY 1993; 21:634-9. [PMID: 8412995 DOI: 10.1002/mpo.2950210905] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Primary intrahepatic malignant nonepithelial tumors are very rare in children and account for 2% of all malignant mesenchymatous tumors under the age of 15 years. Clinical presentation, radiologic features, and histologic types are not unequivocal. The predominant role of surgery takes place either initially in small localized tumors or later, after initial reductive chemotherapy. In all cases, complete resection is the necessary but not sufficient condition for cure. Additional radiotherapy seems ineffective. High-dose chemotherapy and/or liver transplantation can be proposed for resistant cases. The disease-free survival rate is 37% at 2 years for the whole series.
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Affiliation(s)
- A Babin-Boilletot
- Service d'Onco-Hematologie, Centre Hospitalier Régional, Strasbourg, France
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18
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Hansen LK, Kamper J. Hepatic mesenchymoma in childhood: successful combined-modality treatment. Pediatr Hematol Oncol 1992; 9:381-3. [PMID: 1467172 DOI: 10.3109/08880019209016612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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19
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McFadden DW, Kelley DJ, Sigmund DA, Barrett WL, Dickson B, Aron BS. Embryonal sarcoma of the liver in an adult treated with preoperative chemotherapy, radiation therapy, and hepatic lobectomy. Cancer 1992; 69:39-44. [PMID: 1727674 DOI: 10.1002/1097-0142(19920101)69:1<39::aid-cncr2820690109>3.0.co;2-g] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A rare case of embryonal sarcoma of the liver in a 28-year-old man is reported. The patient was treated preoperatively with a combination of chemotherapy and radiation therapy. Complete surgical resection, 4.5 months after diagnosis, consisted of a left hepatic lobectomy. No viable tumor was found in the operative specimen. The patient was disease-free 20 months postoperatively.
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Affiliation(s)
- D W McFadden
- Department of Surgery, University of Cincinnati College of Medicine, Ohio 45267
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20
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Walker NI, Horn MJ, Strong RW, Lynch SV, Cohen J, Ong TH, Harris OD. Undifferentiated (embryonal) sarcoma of the liver. Pathologic findings and long-term survival after complete surgical resection. Cancer 1992; 69:52-9. [PMID: 1727675 DOI: 10.1002/1097-0142(19920101)69:1<52::aid-cncr2820690111>3.0.co;2-l] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Undifferentiated (embryonal) sarcoma of liver is a rare tumor with a reputed poor prognosis. Four patients with this tumor are reported, of whom three were alive without recurrence 1.5, 2.5, and 12 years after initial complete surgical resection, and two of whom received no adjuvant therapy. The fourth patient, in whom complete surgical resection of tumor was not achieved, died with recurrent tumor at 13 months. The latter tumor differed histologically and consisted mainly of closely packed smaller undifferentiated cells with a higher mitotic and apoptotic rate. Eosinophilic globules, characteristic of embryonal sarcoma, were found in some cases to contain condensed nuclear chromatin, evidence of origin from tumor cells dying by apoptosis. One tumor mainly contained large cysts lined by biliary-type epithelium; this suggested an origin from a multipotent precursor cell able to differentiate along both stromal and epithelial lines.
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Affiliation(s)
- N I Walker
- Department of Pathology, Princess Alexandra Hospital, Brisbane, Australia
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21
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Kadomatsu K, Nakagawara A, Zaizen Y, Nagoshi M, Tsuneyoshi M, Fukushige T, Haigou A, Suita S. Undifferentiated (embryonal) sarcoma of the liver: report of three cases. Surg Today 1992; 22:451-5. [PMID: 1421867 DOI: 10.1007/bf00308797] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Undifferentiated (embryonal) sarcoma is a rare malignant tumor of the liver. It typically presents in late childhood and its prognosis is poor. We experienced three cases of such a tumor during the period of 1976-1989; two of these patients are still alive without disease. Each case was independently treated with a combination of surgery and pre- and/or postoperative chemotherapy, which was found to be effective. In one surviving patient, cyclophosphamide and vincristine were found to be effective, while in the other a combination of cisplatin, Adriamycin (ADM), vincristine and cyclophosphamide was observed to induce a rapid reduction in the size of the recurrent tumor. Thus, an adequate combination of surgery and chemotherapy may improve the prognosis of this tumor.
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Affiliation(s)
- K Kadomatsu
- Department of Pediatric Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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22
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 19-1990. A 12-year-old boy with a long travel history and a hepatic mass. N Engl J Med 1990; 322:1378-85. [PMID: 2325736 DOI: 10.1056/nejm199005103221908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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23
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Leuschner I, Schmidt D, Harms D. Undifferentiated sarcoma of the liver in childhood: morphology, flow cytometry, and literature review. Hum Pathol 1990; 21:68-76. [PMID: 2403976 DOI: 10.1016/0046-8177(90)90077-i] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Nine cases of undifferentiated sarcoma of the liver in childhood were investigated by conventional light microscopy, immunohistochemistry, and DNA flow cytometry. Different histologic patterns were discernible. In some cases, areas resembling poorly differentiated rhabdomyosarcoma were present. This histologic diversity was supported by the immunohistologic detection of desmin and cytokeratins in five cases. When evaluated by flow cytometry, four of five cases investigated were diploid; only one was aneuploid, and this patient had the most aggressive course. Follow-up investigations of our patients and those described in the literature revealed that the prognosis of this type of tumor is not as bad as is generally assumed. Of the patients reported in the literature with detailed follow-up information, 37.5% survived without evidence of disease for an average of 37.5 months, death occurred in 47.5% after an average of 11.9 months, and 15.0% were alive with disease.
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Affiliation(s)
- I Leuschner
- Institut für Pathologie, Universität Kiel, FRG
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24
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Chou P, Mangkornkanok M, Gonzalez-Crussi F. Undifferentiated (embryonal) sarcoma of the liver: ultrastructure, immunohistochemistry, and DNA ploidy analysis of two cases. PEDIATRIC PATHOLOGY 1990; 10:549-62. [PMID: 2371180 DOI: 10.3109/15513819009067143] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We describe the histopathologic, immunohistochemical, electronmicroscopic features, and DNA flow cytometric analysis of 2 cases of undifferentiated (embryonal) sarcoma of the liver. The tumor cells were found to be uniformly nonreactive to antibodies that identify cells belonging to the macrophagic-monocytic system. Focal expression of cytokeratin was an unexpected finding. We conclude that the observations are compatible with origin of this sarcoma from primitive mesenchyme. Uncertainty still exists about histogenesis, but the morphologic features of this neoplasm are quite characteristic. Both tumors demonstrate aneuploid stem lines with high S phase. Whether these findings are prognostically significant remains to be seen.
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Affiliation(s)
- P Chou
- Department of Pathology, Northwestern University, Chicago, Illinois 60614
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25
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Steiner M, Bostrum B, Leonard AS, Dehner LP. Undifferentiated (embryonal) sarcoma of the liver. A clinicopathologic study of a survivor treated with combined technique therapy. Cancer 1989; 64:1318-22. [PMID: 2766226 DOI: 10.1002/1097-0142(19890915)64:6<1318::aid-cncr2820640625>3.0.co;2-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Undifferentiated (embryonal) sarcoma is one of the less common primary malignant tumors of the liver that typically, although not exclusively, presents in later childhood. It has come to be recognized as an aggressive neoplasm with the potential for local recurrence and distant metastasis, despite a seemingly successful total surgical resection. This report documents our experience with an 8-year-old boy who had an 80% hepatectomy for an undifferentiated (embryonal) sarcoma, followed by cisplatin (90 mg/m2), doxorubicin (20 mg/m2/d), and radiation therapy (1950 cGy) to the tumor bed. Residual microscopic tumor was very likely present in the region of the inferior vena cava, but exploratory laparotomies for the purpose of "second-look" biopsies were performed with negative results after the completion of each course of chemotherapy. The patient is off of treatment and disease-free 30 months after the diagnosis. Because the survival at this time has been so poor for this highly malignant tumor, we suggest that the combination of therapeutic techniques and second-look laparotomy(s) to identify any subclinical tumor may be a reasonable approach. Ultrastructural and immunohistochemical studies by us and other investigators indicate that the neoplastic cells are primitive mesenchymal cells by electron microscopic study and have immunoreactivity limited to vimentin, alpha-1-antitrypsin, and alpha-1-antichymotrypsin.
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Affiliation(s)
- M Steiner
- Department of Pediatrics, University of Minnesota Medical School, Hospital and Clinic, Minneapolis
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26
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Affiliation(s)
- S Iwatsuki
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania
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27
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Ware R, Friedman HS, Filston HC, Chaffee S, Kurtzberg J, Kinney TR, Falletta JM. Childhood hepatic mesenchymoma: successful treatment with surgery and multiple-agent chemotherapy. MEDICAL AND PEDIATRIC ONCOLOGY 1988; 16:62-5. [PMID: 3340065 DOI: 10.1002/mpo.2950160114] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Malignant undifferentiated sarcoma (mesenchymoma) of the liver is a rare tumor of childhood, with fewer than 100 cases reported in the literature. The overall prognosis for patients with this malignancy is poor. In this report, two children with hepatic mesenchymoma underwent surgical excision followed by 2 years of adjuvant chemotherapy. Rotating cycles of cisplatinum, vincristine/doxorubicin, vincristine/cyclophosphamide, and vincristine/actinomycin D were given with minimal toxicity. Both patients are alive, with no evidence of disease at least 5 years from diagnosis. Previous reports of treatment are reviewed.
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Affiliation(s)
- R Ware
- Division of Hematology/Oncology, Duke University Medical Center, Durham, NC 27710
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28
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Horowitz ME, Etcubanas E, Webber BL, Kun LE, Rao BN, Vogel RJ, Pratt CB. Hepatic undifferentiated (embryonal) sarcoma and rhabdomyosarcoma in children. Results of therapy. Cancer 1987; 59:396-402. [PMID: 3791152 DOI: 10.1002/1097-0142(19870201)59:3<396::aid-cncr2820590307>3.0.co;2-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
From July 1972 through September 1984, 8 of 44 children diagnosed as having primary malignant hepatic tumors, who were treated at St. Jude Children's Research Hospital, had undifferentiated (embryonal) sarcoma (five patients) or rhabdomyosarcoma (three patients). The natural history and response to multimodal therapy of these rare tumors are described. The pathologic material was reviewed and evidence for the differentiating potential of undifferentiated (embryonal) sarcoma is presented. At diagnosis, disease was restricted to the right lobe of the liver in three patients, was bilobar in four patients, and extended from the left lobe into the diaphragm in one patient. Lung metastases were present in two patients at diagnosis. All three patients with rhabdomyosarcoma had intrahepatic lesions without involvement of the biliary tree. Survival ranged from 6 to 73 months from diagnosis (median, 19.5 months); two patients are surviving disease-free for 55+ and 73+ months, and one patient recently underwent resection of a recurrent pulmonary nodule 22 months from initial diagnosis. Three patients died of progressive intrahepatic and extrahepatic abdominal tumors, and two patients, who died of progressive pulmonary tumor, also had bone or brain metastasis but no recurrence of intra-abdominal tumor. Six patients had objective evidence of response to chemotherapy. The authors suggest an aggressive multimodal approach to the treatment of these rare tumors in children.
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