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Jiang P, Jiao Y, Niu CY, Liu YH. Undifferentiated embryonal sarcoma of the liver with epithelioid features in an adult patient: A case report. Medicine (Baltimore) 2021; 100:e28265. [PMID: 34918699 PMCID: PMC10545351 DOI: 10.1097/md.0000000000028265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Undifferentiated embryonal sarcoma of the liver (UESL) is a rare form of liver malignancy, with most cases reported in the pediatric population. This disease is extremely uncommon in adults. Herein, we report the first case of UESL with epithelioid features in an adult patient. PATIENT CONCERNS A 50-year-old man was admitted to our hospital due to epigastric pain. DIAGNOSIS AND INTERVENTIONS Computed tomography and magnetic resonance imaging revealed a space-occupying lesion in the right lobe of the liver. A right hemihepatectomy was performed. Postoperative pathological and immunohistochemical examinations confirmed the diagnosis of UESL and features of epithelioid differentiation. OUTCOMES The patient recovered well and refused adjuvant therapy. Unfortunately, the patient died of tumor recurrence 3 months after hospital discharge. CONCLUSION UESL is a rare form of liver cancer, with most cases reported in the pediatric population. This case study highlights an extremely uncommon case of UESL with epithelioid features and a very poor prognosis. The findings suggest that complete intraoperative resection and postoperative adjuvant therapy should be considered to improve the prognosis of adult patients with UESL with epithelioid features.
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Capozza MA, Ruggiero A, Maurizi P, Mastrangelo S, Attinà G, Triarico S, Vellone M, Giuliante F. Undifferentiated Embryonal Sarcoma of the Liver (UESL) in Adolescents: An Unexpected Diagnosis. J Pediatr Hematol Oncol 2019; 41:e132-e134. [PMID: 29702542 DOI: 10.1097/mph.0000000000001191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Definitive diagnosis of pediatric liver masses can be challenging, because clinical manifestations are nonspecific, and ultimate diagnosis may be delayed. We describe 2 patients with liver masses that initially were misdiagnosed and treated as infectious hepatic lesions. Only after histologic examination the correct diagnosis of undifferentiated embryonal sarcoma of the liver was defined. Both patients underwent a complete tumor resection followed by chemotherapy with a favorable outcome.
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Affiliation(s)
- Michele A Capozza
- Division of Pediatric Oncology, Catholic University of Rome, A. Gemelli Hospital
| | - Antonio Ruggiero
- Division of Pediatric Oncology, Catholic University of Rome, A. Gemelli Hospital
| | - Palma Maurizi
- Division of Pediatric Oncology, Catholic University of Rome, A. Gemelli Hospital
| | - Stefano Mastrangelo
- Division of Pediatric Oncology, Catholic University of Rome, A. Gemelli Hospital
| | - Giorgio Attinà
- Division of Pediatric Oncology, Catholic University of Rome, A. Gemelli Hospital
| | - Silvia Triarico
- Division of Pediatric Oncology, Catholic University of Rome, A. Gemelli Hospital
| | - Maria Vellone
- Hepatobiliary Surgery Unit, Catholic University School of Medicine, A. Gemelli University Hospital, Rome, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Catholic University School of Medicine, A. Gemelli University Hospital, Rome, Italy
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3
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Pulmonary Metastases from an Undifferentiated Embryonal Sarcoma of the Liver: A Case Report and Review. Case Rep Oncol Med 2018; 2018:7840865. [PMID: 30254779 PMCID: PMC6142750 DOI: 10.1155/2018/7840865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant hepatic tumor that occurs primarily in children. Only a limited number of cases have been reported in the literature due to low incidence of one per million, and reports of metastatic lesion of UESL are even rarer. We hereby describe the case of a 13-year-old male who presented with a palpable mass with imaging findings suggestive of a large complex tumor in the right lobe of the liver. He underwent extended right hepatectomy followed by adjuvant chemotherapy. The tumor was confirmed to be UESL by postoperative pathology and immunohistochemical staining analysis. Four years later, surveillance imaging revealed a small lung nodule in the left lower lobe. Complete removal of the lung tumor by wedge resection was performed, and a histological diagnosis of metastatic UESL was made. The patient also received postoperative adjuvant chemotherapy and is currently in a good general condition and tumor-free in the present eight-month period. This case is presented with emphasis on clinicopathological and immunohistochemical findings of the primary UESL and lung metastases with the aim of collecting more data and expanding our understanding of this rare malignancy.
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Beksac K, Mammadov R, Ciftci T, Guner G, Akyol A, Kaynaroglu V. Undifferentiated Embryonal Sarcoma of the Liver in an Adult Patient. Cureus 2018; 10:e3037. [PMID: 30258736 PMCID: PMC6153094 DOI: 10.7759/cureus.3037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
An undifferentiated embryonal sarcoma of the liver (UESL) is a rare and highly malignant mesenchymal neoplasm that is uncommonly observed in adults. We report a case of UESL found in a 26-year-old female. Our case was initially regarded as a type II hydatid cyst and then a malignant mass in radiological studies. The patient underwent nonanatomic liver resection. There were postoperative complications, but they were handled successfully. The patient received taxol-cisplatin-ifosfamide chemotherapy protocol and is disease-free after six years. Although UESL is exceedingly rare in adults, it must be considered while evaluating large hepatic masses since curative resection has an excellent prognosis.
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Affiliation(s)
- Kemal Beksac
- General Surgery, Dr. Abdurrahman Yurtarslan Ankara Oncology Education and Research Hospital, Ankara, TUR
| | | | - Turkmen Ciftci
- Interventional Radiology, Hacettepe University, Ankara, TUR
| | - Gunes Guner
- Pathology, Hacettepe University, Ankara, TUR
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Hanging Undifferentiated Embryonal Sarcoma of the Liver in Adult: an Unusual Presentation of an Aggressive Tumor. J Gastrointest Cancer 2018; 50:689-692. [PMID: 29779073 DOI: 10.1007/s12029-018-0119-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Mori A, Fukase K, Masuda K, Sakata N, Mizuma M, Ohtsuka H, Morikawa T, Nakagawa K, Hayashi H, Motoi F, Naitoh T, Murakami K, Unno M. A case of adult undifferentiated embryonal sarcoma of the liver successfully treated with right trisectionectomy: a case report. Surg Case Rep 2017; 3:19. [PMID: 28144858 PMCID: PMC5285294 DOI: 10.1186/s40792-017-0295-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/24/2017] [Indexed: 12/14/2022] Open
Abstract
Background Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant mesenchymal tumor that usually occurs in children and is rarely diagnosed in adults. Case presentation Here, we describe the case of a 65-year-old woman who presented with a huge cystic lesion in the liver. Laboratory studies performed on admission showed modest inflammation, poor nutrition, and elevated levels of total bilirubin, alkaline phosphatase, and γ-glutamyl transferase. Computed tomography showed a well-defined, heterogeneous tumor with multiple cysts involving the right lobe and the medial segment of the liver, with a maximum diameter of 16 cm. Positron emission tomography/computed tomographic scans showed the uptake of 2-(fluorine-18)-fluoro-2-deoxy-d-glucose in a part of the cyst. The patient was diagnosed with mucinous cystadenocarcinoma or sarcoma of the liver and underwent right trisectionectomy. Histopathological studies revealed that the tumor was composed of pleomorphic and polynuclear dyskaryotic cells with eosinophilic globules in the cytoplasm. Mesenchymal hamartoma-like tissue was observed in the peripheral part of the tumor. Immunohistochemical analyses showed the tumor stained with vimentin, α-smooth muscle actin, desmin, α1-antitrypsin, and α1-antichymotripsin. Therefore, a histological diagnosis of UESL was made. Eighteen months following treatment, two recurrent tumors in the remnant liver were detected and resection of the recurrent tumors was performed. Conclusions A UESL should be considered in the differential diagnosis of large cystic hepatic lesions. Although the prognosis of UESL is extremely unfavorable, aggressive surgical resection should be the most important factor for ensuring long-term survival.
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Affiliation(s)
- Akiko Mori
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Koji Fukase
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kunihiro Masuda
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Naoaki Sakata
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Keigo Murakami
- Department of Pathology, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
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Imaging of Rare Primary Malignant Hepatic Tumors in Adults With Histopathological Correlation. J Comput Assist Tomogr 2017; 40:452-62. [PMID: 26938690 DOI: 10.1097/rct.0000000000000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma and cholangiocarcinoma are the most common primary liver malignancies in adults (comprising >85%); however, liver is also host to some unusual primary malignant tumors. Some of these tumors show distinct demographic, clinicopathologic, and imaging features. Imaging features of these uncommon primary malignant liver tumors are presented with an attempt to correlate them with histopathology.
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9
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Congenital Adrenal Neuroblastoma With and Without Cystic Change: Differentiating Features With an Emphasis on the of Value of Ultrasound. AJR Am J Roentgenol 2016; 207:1105-1111. [PMID: 27556888 DOI: 10.2214/ajr.16.16452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the features of congenital adrenal neuroblastomas with and without cystic changes and to emphasize the value of ultrasound in the diagnostic evaluation of cystic congenital adrenal neuroblastoma. MATERIALS AND METHODS A total of 41 patients with surgically confirmed congenital adrenal neuroblastoma were enrolled. We divided the patients into two groups according to presence or absence of cystic change in the tumor, as determined from the initial ultrasound findings. Clinical and laboratory findings, disease stage, and patient outcome were investigated with a statistical comparison between the two groups. The imaging findings for cystic congenital adrenal neuroblastoma were reviewed to compare the additional diagnostic value of CT and MRI when paired with ultrasound. RESULTS There were 22 patients (54%) in the group without cystic changes and 19 patients (46%) in the group with cystic changes. Prenatal detection and absence of metastasis were significantly more common in the cystic group than in the noncystic group (p < 0.05). Sensitivities of tumor marker levels were also significantly lower in the cystic group. Patient outcome was excellent, and there was no significant difference between the groups. With regard to imaging of cystic congenital adrenal neuroblastoma, in the 15 cases in which CT or MRI was paired with ultrasound, no additional diagnostic information was discerned with CT or MRI. CONCLUSION Nearly one-half of congenital adrenal neuroblastomas are cystic, and these tumors have clinical and laboratory features that distinguish them from noncystic congenital adrenal neuroblastoma. Diagnostic tests, including CT, MRI, and assessment of tumor markers, have low diagnostic value in the evaluation of cystic congenital adrenal neuroblastoma.
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10
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Zhang H, Lei L, Zuppan CW, Raza AS. Undifferentiated embryonal sarcoma of the liver with an unusual presentation: case report and review of the literature. J Gastrointest Oncol 2016; 7:S100-6. [PMID: 27034807 PMCID: PMC4783619 DOI: 10.3978/j.issn.2078-6891.2015.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/27/2015] [Indexed: 12/13/2022] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant mesenchymal neoplasm, relatively unique to the liver that occurs primarily in children and teenagers. Delay in diagnosis is not uncommon due to lack of a characteristic clinical presentation, serological markers and radiological changes. We report a case of UESL in a 9-year-old girl who presented with right upper quadrant pain and a palpable mass. Laboratory and imaging workup revealed a complex hepatic cyst, increased IgE, transient peripheral eosinophilia and a normal alpha-fetoprotein (AFP). Initial empirical treatment with albendazole was implemented for presumed hydatid cyst disease, but the child failed to improve. Subsequent surgical resection resulted in the correct diagnosis of UESL. She received 6 months of chemotherapy and remains well with no evidence of tumor about 12 months after resection. We herein review the typical clinical, radiologic and pathologic features of this rare tumor.
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Affiliation(s)
- Huina Zhang
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Li Lei
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Craig W Zuppan
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Anwar S Raza
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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11
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Simo KA, Mckillop IH, Ahrens WA, Martinie JB, Iannitti DA, Sindram D. Invasive biliary mucinous cystic neoplasm: a review. HPB (Oxford) 2012; 14:725-40. [PMID: 23043661 PMCID: PMC3482668 DOI: 10.1111/j.1477-2574.2012.00532.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Biliary mucinous cystic neoplasms (BMCNs) are recently redefined rare liver tumours in which insufficient recognition frequently leads to an incorrect initial or delayed diagnosis. A concise review of the subtle, sometimes non-specific, clinical, serologic and radiographic features will allow for a heightened awareness and more comprehensive understanding of these entities. METHODS Literature relating to the presentation, diagnosis, treatment, pathology and outcomes of BMCNs and published prior to March 2012 was reviewed. RESULTS Biliary mucinous cystic neoplasms most commonly occur in females (≥60%) in the fifth decade of life. Clinical symptoms, serologic markers and imaging modalities are unreliable for diagnosis of BMCNs, which leads to misdiagnosis in 55-100% of patients. Perioperative cyst aspiration is not recommended as invasive BMCNs can only be differentiated from non-invasive BMCNs by microscopic evaluation for the presence of ovarian-type stroma. Intraoperative biopsy and frozen section(s) are essential to differentiate BMCNs from other cystic liver lesions. The treatment of choice is complete excision and can result in excellent survival with initial correct diagnosis. CONCLUSIONS A low threshold for considering BMCN in the differential diagnosis of cystic liver lesions and increased attentiveness to its subtle diagnostic characteristics are imperative. The complete surgical resection of BMCNs and the use of appropriate nomenclature are necessary to improve outcomes and accurately define prognosis.
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Affiliation(s)
- Kerri A Simo
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - Iain H Mckillop
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - William A Ahrens
- Department of Pathology, Carolinas Medical CenterCharlotte, NC, USA
| | - John B Martinie
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - David A Iannitti
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - David Sindram
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
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12
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Rare case of adult undifferentiated (embryonal) sarcoma of the liver treated with liver transplantation: excellent long-term survival. Case Reports Hepatol 2012; 2012:519741. [PMID: 25374706 PMCID: PMC4208439 DOI: 10.1155/2012/519741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 08/22/2012] [Indexed: 12/14/2022] Open
Abstract
We present the case of a 54-year-old gentleman who presented with abdominal distension and a CT scan of his abdomen revealed a large (25 cm) left hepatic lobe tumor. He received chemotherapy for over 1.5 years. The CT scans at the completion of this therapy revealed that the tumor had actually slightly grown in size. He underwent orthotopic liver transplantation without any major complications. The explant histopathology revealed an undifferentiated embryonal cell sarcoma (UECS) composed of relatively bland spindled cells arranged in short fascicles. It is now 10 years and 3 months since his last transplant and the patient remains well with no tumor recurrence.
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13
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Sodhi KS, Bekhitt E, Rickert C. Paradoxical hepatic tumor: Undifferentiated embryonal sarcoma of the liver. Indian J Radiol Imaging 2011; 20:69-71. [PMID: 20352000 PMCID: PMC2844756 DOI: 10.4103/0971-3026.59760] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Undifferentiated embryonal sarcoma (UES) is a rare primary malignant tumor of the liver that typically presents in late childhood. We report a case of primary UES, which had a typical paradoxical appearance on different imaging modalities.
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Medical Imaging, Royal Children's Hospital, Melbourne, Victoria 3052, Australia
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14
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Abstract
The investigation of hepatobiliary tumors, in the pediatric population, usually begins with an ultrasonographic (US) examination. It is readily available without ionizing radiation and does not need sedation. Therefore US is an outstanding imaging modality for screening and follow-up. Doppler and color Doppler interrogation are part of the examination to assess vascularity of the lesions and vascular anatomy. Magnetic resonance imaging is a comprehensive imaging modality with multiplanar capability to assess the liver parenchyma, gallbladder, and biliary tree and is free of ionizing radiation. This article highlights the current status of imaging of the most common hepatobiliary tumors in children.
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Affiliation(s)
- Ricardo Faingold
- Department of Medical Imaging, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
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15
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Anil G, Fortier M, Low Y. Cystic hepatic mesenchymal hamartoma: the role of radiology in diagnosis and perioperative management. Br J Radiol 2011; 84:e91-4. [PMID: 21511744 DOI: 10.1259/bjr/41579091] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 13-month-old male presented with large hepatic mass that was confirmed diagnostically to be a cystic hepatic mesenchymal hamartoma. The sieve-like appearance of the solid components of the mass, as seen at ultrasonography, and findings of dynamic post-contrast MRI are highlighted here. Beyond diagnostic imaging, we extended our role in patient management through ultrasound-guided intra-operative aspiration of fluid from the cystic components of the tumour to reduce its volume and thereby facilitate surgical resection.
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Affiliation(s)
- G Anil
- Department of Diagnostic Imaging, K K Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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16
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Castrillon GA, Sepúlveda E, Yepez NL, Hoyos S, Osorio G. Hepatic transplantation in a child with giant multicystic tumor: pathological and imaging findings. Pediatr Transplant 2010; 14:e58-61. [PMID: 19413715 DOI: 10.1111/j.1399-3046.2009.01166.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 30-month-old male white child presented with 13 months of increasing abdominal girth. The MRI and MDCT showed a giant heterogeneous and predominantly cystic mass with thick and nodular septation, measuring approximately 18 x 15 x 20 cm, which occupied almost the whole liver. A histological diagnosis was not possible, which necessitated transplantation. One yr after transplantation the course has been satisfactory without recurrence and with normal hepatic function and negative tumor markers.
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Affiliation(s)
- Germán A Castrillon
- Department of Radiology and Gastrohepatology Group, Universidad de Antioquia, Medellín, Colombia.
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17
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Yoon JY, Lee JM, Kim DY, Choi GH, Park YN, Chung JW, Kim EY, Park JY, Ahn SH, Han KH, Chon CY. A case of embryonal sarcoma of the liver mimicking a hydatid cyst in an adult. Gut Liver 2010; 4:245-9. [PMID: 20559529 DOI: 10.5009/gnl.2010.4.2.245] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 08/29/2009] [Indexed: 12/28/2022] Open
Abstract
An undifferentiated (embryonal) liver sarcoma (ULS) originates from a primitive mesenchymal cell, with a predilection for childhood and very rare occurrence in adults. We report a case of a ULS that was incidentally found in a 53-year-old female. Our case was initially interpreted as a large hydatid cyst, which was later suspected to be a neoplastic lesion because its size was increasing and a solid portion was newly detected after shrinkage of the cyst following drainage. The patient underwent successful right hepatic lobectomy with complete resection, and is currently disease-free without adjuvant therapy. Although it is difficult to diagnose a hepatic cyst as a ULS due to its rare occurrence in adulthood and lack of specific findings, its possibility should be considered, especially when its size is increasing, because early diagnosis and curative resection are necessary for a favorable outcome.
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Affiliation(s)
- Jin Young Yoon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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19
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Abstract
Imaging plays a crucial role in the management of a child with a suspected liver tumor. There are various important differences between pediatric and adult practice, and in particular several liver tumor types that are almost never seen in adults are not uncommon in children. The radiologist makes important contributions to the diagnosis through non-invasive imaging and often biopsy. This paper describes imaging tips for the radiologist, including a discussion of the PRETEXT system for staging primary malignant tumors.
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Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, WC1N 3JH, UK.
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20
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Diagnosis of undifferentiated embryonal sarcoma of the liver-importance of combined studies of ultrasound and CT scan. J Pediatr Hematol Oncol 2009; 31:797-8. [PMID: 19770684 DOI: 10.1097/mph.0b013e3181b534e6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Undifferentiated embryonal sarcoma is the uncommon malignant mesenchymal tumor of the liver seen in children and young adults. Radiologic findings reflect the solid to cystic appearances observed in the gross specimens. The discrepancy in the appearances of the mass between the ultrasound scan and computed tomography scan is the hall mark of this tumor. Ultrasonography typically show a large mass which is hyperechoic or isoechoic (solid). Computed tomography shows cystic component of the tumor. This unique radiologic feature will help in the diagnosis of the tumour.
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21
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Imaging of paediatric liver tumours with pathological correlation. Clin Radiol 2009; 64:1015-25. [PMID: 19748008 DOI: 10.1016/j.crad.2009.04.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 04/26/2009] [Accepted: 04/28/2009] [Indexed: 01/01/2023]
Abstract
Paediatric hepatic tumours are relatively rare with malignant lesions being twice as frequent as benign neoplasms and are mostly metastases. Imaging has a significant role in the evaluation of most paediatric liver tumours. Differentiating benign from malignant tumours is important as it significantly affects treatment decisions. We present the characteristic radiological and pathological features of the most common paediatric liver tumours.
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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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Ma L, Liu YP, Geng CZ, Tian ZH, Wu GX, Wang XL. Undifferentiated embryonal sarcoma of liver in an old female: Case report and review of the literature. World J Gastroenterol 2008; 14:7267-70. [PMID: 19084947 PMCID: PMC2776890 DOI: 10.3748/wjg.14.7267] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The clinical characteristics of undifferentiated (embryonal) sarcoma of the liver (UESL) were investigated and the best treatment modalities were recommended. Both histology and immuno-histochemistry demonstrated the cellular features of this peculiar tumor. The tumor size was 12 cm × 9 cm × 8 cm in the right liver lobe. The patient underwent surgical resection of the tumor. The postoperative recovery was uneventful and she died eight months after diagnosis. The tumor showed mixed spindle and polygonal cells within the myxoid matrix. Some tumor cells contained eosinophilic hyaline globules that were positive for resistant diastase. Immunohistochemistry showed positive vimentin. Stellate and spindle cells were positively stained with alpha-1-antichymotrypsin (AACT) and CD68. This case indicates that UESL is not obviously differentiated in old-aged adults.
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Chat L, Mahi M, Chellaoui M, Khattab M, Benamour-Ammar H. [Embryonal rhabdomyosarcoma of the liver: an unusual site of origin]. JOURNAL DE RADIOLOGIE 2007; 88:72-4. [PMID: 17299371 DOI: 10.1016/s0221-0363(07)89793-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Almogy G, Lieberman S, Gips M, Pappo O, Edden Y, Jurim O, Simon Slasky B, Uzieli B, Eid A. Clinical outcomes of surgical resections for primary liver sarcoma in adults: results from a single centre. Eur J Surg Oncol 2004; 30:421-7. [PMID: 15063896 DOI: 10.1016/j.ejso.2004.01.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2004] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Primary hepatic sarcoma is a rare tumour with a poor prognosis. METHODS From 1997 to 2002 eight patients had liver resection for primary sarcoma of the liver at our institution. The clinical characteristics, imaging findings, surgical procedures, adjuvant therapy and outcome were retrospectively reviewed. There were two patients each with angiosarcoma (AS), leiomyosarcoma (LMS), and undifferentiated embryonal sarcoma (UES), one patient with epithelioid hemangioendothelioma (EHE) and one patient with malignant peripheral nerve sheath sarcoma (PNSS). RESULTS The most common presenting symptoms were right upper quadrant pain and fever. Typical imaging findings were a heterogenous mass with poorly defined margins, pseudocapsule and aberrant vasculature. Preoperative diagnosis of a primary liver sarcoma was made in 7/8 cases, either by fine needle aspiration (n = 5) or angiography (n = 2). Five right hepatectomies and three trisegmentectomies were performed. An R (0) resection was possible in three cases. Two patients developed complications and there was one death. Adjuvant chemoradiotherapy was administered to 5/7 patients. Systemic chemotherapy led to tumour regression in both patients with UES which enabled a second hepatic resection. CONCLUSIONS The majority of patients with primary liver sarcoma present with right upper quadrant pain, fever and a liver mass. Differentiating the rare primary liver sarcoma from the much more common hepatocellular carcinoma (HCC) may aid in planning therapy. Patients with resectable tumours should be referred for surgery. Liver resection combined with adjuvant chemotherapy are the mainstays of treatment for UES in the adult.
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Affiliation(s)
- Gidon Almogy
- Department of Surgery, Hadassah University Hospital, Jerusalem, Israel.
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Chowdhary SK, Trehan A, Das A, Marwaha RK, Rao KLN. Undifferentiated embryonal sarcoma in children: beware of the solitary liver cyst. J Pediatr Surg 2004; 39:E9-12. [PMID: 14694398 DOI: 10.1016/j.jpedsurg.2003.09.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Undifferentiated embryonal sarcoma (UES) of liver is a rare form of liver tumor in children. It may have an atypical presentation leading to delay in diagnosis. The authors report on 3 consecutive children with this condition, each of them presenting in older children who presented with this condition and an initial diagnostic dilemma. One of them presented initially with a solitary cyst, the second with severe abdominal pain, and the third with intermittent fever. Preoperative chemotherapy was successful in shrinking the tumors in 2 children to allow anatomic liver resection with tumor-free margin. Both remain free of recurrence 2 years after completing treatment.
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Affiliation(s)
- S K Chowdhary
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kim DY, Kim KH, Jung SE, Lee SC, Park KW, Kim WK. Undifferentiated (embryonal) sarcoma of the liver: combination treatment by surgery and chemotherapy. J Pediatr Surg 2002; 37:1419-23. [PMID: 12378446 DOI: 10.1053/jpsu.2002.35404] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND/PURPOSE Undifferentiated (embryonal) sarcoma of the liver (USL) is a rare malignancy found in older children, and the most appropriate treatment strategy has been controversial. The authors report the tumor's clinical characteristics and the results of management in 6 children and recommend the best treatment plans based on these findings. METHODS Six USL pathologically verified at Seoul National University Children's Hospital between 1990 and 2000 were reviewed retrospectively. RESULTS The mean age at diagnosis of USL was 10.3 years (range, 7 to 13 years). There were 2 girls and 4 boys; 5 of 6 children presented with large abdominal mass, one with weight loss. Tumors ranged in size from 8.5 x 9.0 cm to 15.0 x 15.0 cm. Location of the tumor varied from right lobe in 4 to left lobe in one, and both lobes in one. Three children underwent primary complete resection without preoperative chemotherapy. Partial resection of the tumor was done in one child because of encasing inferior vena cava and hepatic vein. However, complete resection was possible at second-look operation after chemotherapy. Two children underwent complete resection after chemotherapy. Preoperative chemotherapy allowed successful resection of 3 USL, which were initially considered unresectable. Postoperative recovery for all children was uneventful. Chemotherapy according to the the Third Intergroup Rhabdomyosarcoma Study (IRS III) was administered to all except one child who refused further postoperative chemotherapy after having had severe complications during the first cycle of chemotherapy. One child with partial resection died of sepsis at 22 months after diagnosis during postoperative chemotherapy after complete surgical removal of the tumor. Five children are alive without recurrence at 40, 45, 48, 60, and 122 months, respectively, after diagnosis. CONCLUSION The combined therapy of surgery and chemotherapy in USL can improve the prognosis.
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Affiliation(s)
- Dae-Yeon Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
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Abstract
In many clinical scenarios, liver imaging does not differ as greatly in children as in adults. Common indications for liver imaging in children include trauma, suspected mass, pre-transplantation studies, monitoring after liver transplantation, jaundice, or liver dysfunction. This article highlights areas in which pathology or imaging approach in children differs from that seen in adults. Topics covered include imaging of a suspected hepatic mass, neonatal jaundice, and segmental liver transplantation.
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Affiliation(s)
- Lane F Donnelly
- Department of Radiology, Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.
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29
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Araújo Neto SAD, Souza ASD. Sarcoma embrionário indiferenciado do fígado: relato de caso. Radiol Bras 2001. [DOI: 10.1590/s0100-39842001000500011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O sarcoma embrionário indiferenciado do fígado é uma entidade rara que acomete, principalmente, crianças acima dos cinco anos de idade. O aspecto macroscópico consiste, caracteristicamente, de grande massa hepática com maior componente sólido, porém apresenta algumas áreas císticas. Curiosamente, a tomografia computadorizada superestima o componente cístico da lesão, sendo a ultra-sonografia um método mais fidedigno na demonstração da consistência do tumor. Os estudos por imagem ajudam a afastar enfermidades não-neoplásicas, como abscessos e hematomas hepáticos, e avaliam a extensão das lesões. O diagnóstico de sarcoma embrionário indiferenciado pode ser corretamente presumido quando se consideram os achados de imagem em conjunto com a idade do paciente e o nível de alfa-fetoproteína. Os autores descrevem um caso de sarcoma embrionário indiferenciado no fígado de uma criança do sexo feminino de dez anos de idade, enfatizando seus aspectos imagenológicos e o diagnóstico diferencial.
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Abstract
Common indications for liver imaging in children include trauma, suspected mass, pre-liver transplantation, monitoring after liver transplantation, jaundice, or liver dysfunction. This article highlights areas where the pathology or imaging approach in children differs from that seen in adults. Topics covered include imaging of a suspected hepatic mass, neonatal jaundice, and segmented liver transplantation.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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IMAGING OF GASTROINTESTINAL MALIGNANCY IN CHILDHOOD. Radiol Clin North Am 1996. [DOI: 10.1016/s0033-8389(22)00505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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