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Cheon M, Yi H, Ha JY, Kim MA. Atypical 18F-FDG PET-CT Findings in a Rare Case of Primary Hepatic Leiomyosarcoma. Diagnostics (Basel) 2024; 14:1502. [PMID: 39061638 PMCID: PMC11275497 DOI: 10.3390/diagnostics14141502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
The primary hepatic leiomyosarcoma is a rare malignant tumor arising from the smooth muscle cells in the hepatic vessels, bile ducts, and ligamentum teres. It is considered a subtype of hepatic sarcomas. We report awkward 18F-FDG PET-CT findings of a primary hepatic leiomyosarcoma masquerading as a benign hepatic tumor, which were confirmed by histopathological and immunohistochemical examinations in a 78-year-old woman.
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Affiliation(s)
- Miju Cheon
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
| | - Hyunkyung Yi
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
| | - Joo Young Ha
- Division of Hematology and Oncology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
| | - Min A Kim
- Department of Pathology, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
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Lu T, Yang W, Liu X, Yang X, Yang C, Di W. Imaging Findings of Hepatic Ewing's Sarcoma on Computed Tomography and Gadobenate Dimeglumine-enhanced Magnetic Resonance Imaging: A Case Report and Literature Review. J Clin Transl Hepatol 2022; 10:564-569. [PMID: 35836756 PMCID: PMC9240243 DOI: 10.14218/jcth.2021.00129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/22/2021] [Indexed: 12/04/2022] Open
Abstract
Ewing's sarcoma (ES) is a tumor that often occurs in the long bones and rarely arises from visceral organs primarily. Here, we report a case of primary hepatic ES, discuss its computed tomography (CT) and gadobenate dimeglumine-enhanced magnetic resonance (MRI) features. This is the first Chinese and fifth primary hepatic ES case reported, based on a literature review. Imaging examinations showed that the tumor was solid, with necrosis and hemorrhage. Contrast-enhanced images showed that the tumor was hypervascular and especially had heterogeneous signal intensity on hepatobiliary phase MRI images. Intratumoral vessels and vascular invasion were also present.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wenhao Yang
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Xingchao Liu
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Xudan Yang
- Department of Pathology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chong Yang
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
- Correspondence to: Wenjia Di and Chong Yang, Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China. ORCID: https://orcid.org/0000-0002-0060-706X (CY). Tel: +86-28-8739-3707, Fax: +86-28-8778-5585, E-mail: (WD), (CY)
| | - Wenjia Di
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
- Correspondence to: Wenjia Di and Chong Yang, Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China. ORCID: https://orcid.org/0000-0002-0060-706X (CY). Tel: +86-28-8739-3707, Fax: +86-28-8778-5585, E-mail: (WD), (CY)
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A Unique Case of the Transformation of a Hepatic Leiomyoma into Leiomyosarcoma with Pancreatic Metastases: Review of the Literature with Case Presentation. REPORTS 2021. [DOI: 10.3390/reports5010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary hepatic leiomyoma (PHL) is a rare entity, with very few cases reported in the literature. Even more rarely, until now practically undescribed, is the transformation of a hepatic leiomyoma into leiomyosarcoma with pancreatic metastases. Here, we report a single case of the progression of PHL in primary hepatic leiomyosarcoma, with clinical–surgical and histopathological features, and we conducted a review of the literature of related cases that can be found.
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Narahara S, Nagaoka K, Tateyama M, Miyamoto H, Tanaka K, Tokunaga T, Kawasaki T, Yoshimaru Y, Watanabe T, Setoyama H, Naoe H, Tanaka M, Sasaki Y, Tanaka Y. A case of primary hepatic leiomyosarcoma treated with multi-line chemotherapy. KANZO 2021; 62:538-547. [DOI: 10.2957/kanzo.62.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
- Satoshi Narahara
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | | | - Masakuni Tateyama
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Hideaki Miyamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Kentaro Tanaka
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Takayuki Tokunaga
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Takeshi Kawasaki
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Yoko Yoshimaru
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Takehisa Watanabe
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Hiroko Setoyama
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Hideaki Naoe
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Motohiko Tanaka
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Yutaka Sasaki
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University
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Esposito F, Lim C, Baranes L, Salloum C, Feray C, Calderaro J, Azoulay D. Primary leiomyosarcoma of the liver: Two new cases and a systematic review. Ann Hepatobiliary Pancreat Surg 2020; 24:63-67. [PMID: 32181431 PMCID: PMC7061050 DOI: 10.14701/ahbps.2020.24.1.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 12/12/2022] Open
Abstract
Primary hepatic leiomyosarcoma (PHL) is a rare malignant tumor, which originates from smooth muscles. Clinical presentation and imaging features are non-specific and can mimick the most frequent primary liver tumors namely hepatocellular carcinoma and intrahepatic cholangiocarcinoma. We report here two cases of PHL including one from the portal vein. The literature was searched for studies reporting cases of PHL reported from 2011 and 2019. The two patients were operated with R0 resection. Diagnosis of PHL was confirmed by histopathological and immunohistochemical examinations. Surgery remains the mainstay of the management of PHL. R0 resection is the main prognostic factor. Our literature search identified 16 additional cases from 12 reports. Preoperative diagnosis of PHL needs a high degree of suspicion due to atypical clinical presentation and non-specific imaging features. Surgery is the mainstay of the management of PHL. R0 resection is the main prognostic factor.
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Affiliation(s)
| | - Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Chady Salloum
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France
| | - Cyrille Feray
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France
| | | | - Daniel Azoulay
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France.,Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Vella S, Cortis K, Pisani D, Pocock J, Aldrighetti L. Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy. BMJ Case Rep 2020; 13:13/2/e233567. [PMID: 32047090 DOI: 10.1136/bcr-2019-233567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We describe the case of a 77-year-old woman, presenting with non-specific epigastric pain. Physical examination and subsequent imaging revealed the presence of a large mass in the right liver lobe. This was shown to be a leiomyosarcoma on biopsy histology. Further investigation confirmed this to be a primary hepatic leiomyosarcoma with no evidence of metastases. The patient underwent successful surgical resection. She is currently under imaging follow-up, with no evidence of disease recurrence.
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Affiliation(s)
- Stephanie Vella
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | - Kelvin Cortis
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | - David Pisani
- Pathology Department, Mater Dei Hospital, Msida, Malta
| | - James Pocock
- Gastroenterology Department, Mater Dei Hospital, Msida, Malta
| | - Luca Aldrighetti
- Hepatobiliary Surgery Department, San Raffaele Hospital, Milano, Lombardia, Italy
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Feretis T, Kostakis ID, Damaskos C, Garmpis N, Mantas D, Nonni A, Kouraklis G, Dimitroulis D. Primary Hepatic Leiomyosarcoma: a Case Report and Review of the Literature. ACTA MEDICA (HRADEC KRÁLOVÉ) 2019; 61:153-157. [PMID: 30664449 DOI: 10.14712/18059694.2018.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Primary hepatic leiomyosarcoma is an extremely rare type of liver sarcoma with relatively poor prognosis, with about 50 cases having been reported in the literature. Potential origins of this tumor in the liver are the smooth muscle cells in the round ligament, intrahepatic blood vessels and intrahepatic bile ducts. There is no apparent sex predilection and there is a wide age range. The clinical presentation is not specific and the diagnosis depends on the expression of markers such as smooth muscle actin, desmin and vimentin by tumor cells. PATIENTS AND METHODS Herein, we present a case of a bulky primary hepatic leiomyosarcoma in a 68-year-old female patient. The patient underwent resection of the exophytic mass en block with the hepatic segments III and IVB. CONCLUSION Surgical resection is the most effective among the treatment options.
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Affiliation(s)
- Themistoklis Feretis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Afroditi Nonni
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Liu W, Liang W. Primary hepatic leiomyosarcoma presenting as a thick-walled cystic mass resembling a liver abscess: A case report. Medicine (Baltimore) 2018; 97:e13861. [PMID: 30572556 PMCID: PMC6319981 DOI: 10.1097/md.0000000000013861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Hepatic leiomyosarcoma is a rare malignant tumor, and in rare instances, its combination with fever may lead to misdiagnosis of liver abscess. In our case, the presence of the tumor was considered by the presence of blood vessels through the observation of hepatic tumor wall. PATIENT CONCERNS A 38-year-old woman who had been diagnosed with a liver abscess in a local hospital consulted our institution by complaining left upper quadrant pain and fever. The diagnosis was questioned in our workup, since no obvious inflammatory marker was found in the circulation, and contrast-enhanced computed tomography revealed a huge thick-walled mass in the right liver with multiple tortuous vessels within the wall. DIAGNOSIS Imaging revealed a neoplastic lesion rather than liver abscess. The enhancement of the solid tumor tissues was reduced during the portal phase and delayed phase, which was consistent with a wash-out enhancement. The histopathologic and immunohistochemical results confirmed the diagnosis was primary hepatic leiomyosarcoma. A pulmonary nodule during the postoperative follow-up was diagnosed as metastatic leiomyosarcoma tumor through surgery. INTERVENTIONS A right hepatectomy was performed to cure the hepatic mass. In the follow-up, a metastatic tumor in the lung was resected, followed by chemotherapy. OUTCOMES Lung metastasis and liver recurrence occurred at 25 and 39 months after liver surgery, respectively. Then the patient was lost to follow-up. LESSONS Leiomyosarcoma is associated with a dismal prognosis, but outcomes for these patients may be improved by the combined surgical resection and chemotherapy.
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Affiliation(s)
- Weihai Liu
- Department of Radiology, Beilun Branch Hospital of the First Affiliated Hospital, College of Medicine, Zhejiang University, the People's Hospital of Beilun District, Ningbo
| | - Wenjie Liang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Mitra S, Rathi S, Debi U, Dhiman RK, Das A. Primary Hepatic Leiomyosarcoma: Histopathologist's Perspective of a Rare Case. J Clin Exp Hepatol 2018; 8:321-326. [PMID: 30302051 PMCID: PMC6175749 DOI: 10.1016/j.jceh.2018.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
Primary hepatic leiomyosarcoma is a rare primary mesenchymal tumor of the liver requiring exclusion of any other primary site of origin and histological and immunohistochemical exclusion of other hepatic/extrahepatic tumors with spindle cell morphology. Only about 70 cases are reported in the English literature and many of these tumors have predisposing conditions in the form of immunosuppression or associated malignancies. The occurrence of this tumor in the immunocompetent individual is also known. Histomorphology of this tumor shows a spindle cell lesion which needs to be distinguished from other spindle cell lesions of this region. The main diagnostic challenge of this tumor lies in its rarity, lack of awareness and morphological mimickers in the given site. A complete range of immunohistochemical markers is required to distinguish the lesion from its close morphological mimickers. Here, we discuss a case of primary hepatic leiomyosarcoma in an adult female patient with detailed histomorphological differentials and respective immunoprofiles.
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Key Words
- AFP, Alpha Fetoprotein
- CEA, Carcinoembryonic Antigen
- CEMRI, Contrast Enhanced Magnetic Resonance Imaging
- EBER-ISH
- EBER-ISH, Epstein Barr Encoded RNA-In Situ Hybridization
- EBV, Epstein-Barr Virus
- FDG, Fluorodeoxyglucose
- FNAC, Fine Needle Aspiration Cytology
- GIST, Gastrointestinal Stromal Tumor
- PET-CT, Positron Emission Tomography – Computed Tomography
- SMA
- SMA, Smooth Muscle Antigen
- TPCT, Triple Phasic Computed Tomography
- UGIE, Upper Gastrointestinal Endoscopy
- USG, Ultrasonography
- gastrointestinal stromal tumor
- immunocompetent
- primary hepatic leiomyosarcoma
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Affiliation(s)
- Suvradeep Mitra
- Senior Resident, Department of Histopathology, PGIMER, Chandigarh, India
| | - Sahaj Rathi
- Senior Resident, Department of Hepatology, PGIMER, Chandigarh, India
| | - Uma Debi
- Assistant Professor, Department of Radiology, PGIMER, Chandigarh, India
| | - Radha K. Dhiman
- Professor and Head, Department of Hepatology, PGIMER, Chandigarh, India
| | - Ashim Das
- Professor, Department of Histopathology, PGIMER, Chandigarh, India,Address for correspondence: Ashim Das, Professor, PGIMER, Department of Histopathology, Research Block A, 5th Floor, Chandigarh 160012, India. Tel.: +91 9872223744.
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