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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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Abstract
The authors suggest that laparoscopic techniques may be feasible in the pediatric patient with rare, benign hepatic cysts. Benign congenital liver cysts are rare in the pediatric population and often present a challenge in the diagnosis. Therefore, with recent advances in the field of minimally invasive surgery, this technique may be ideal in achieving both diagnosis and curative resection. We describe the case of a 2-month-old female initially referred for an antenatal ultrasound in the third trimester revealing a 7-cm intraabdominal cystic lesion of unknown origin. She was found to have a 10-cm hepatic cyst successfully treated by laparoscopic surgery. Our approach consisted of complete cyst excision along with its attached hepatic parenchyma. We recommend this technique as safe and feasible.
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Affiliation(s)
- Parissa Tabrizian
- Department of Surgery, Division of Pediatric Surgery, The Mount Sinai Medical Center, 5 E 98th St, Box 1259, 15th floor, New York, NY 10029, USA.
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Jain P, Shah H, Parelkar S. Laparoscopic deroofing of congenital solitary liver cyst in a neonate managed at day 16 of life. J Laparoendosc Adv Surg Tech A 2008; 18:477-80. [PMID: 18503389 DOI: 10.1089/lap.2007.0186] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Congenital liver cysts are uncommon lesions, which are being recognized with the increasing use of antenatal ultrasound. In this paper, we report a case of an antenatally diagnosed solitary simple liver cyst managed by laparoscopic deroofing. Laparoscopy confirmed the diagnosis and gave information about the relation of the cyst with the liver and portal structures. Laparoscopic deroofing is a safe, effective means of management of the liver cyst in pediatric patients.
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Affiliation(s)
- Prashant Jain
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India.
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Pereira IMR, Álvares BR, Baracat J, Martins DL, Pereira RMR. Estudo de 50 casos por tomografia computadorizada de lesões hipodensas hepáticas fundamentais na infância. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000200006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Relatar os diferentes aspectos tomográficos das lesões hepáticas hipodensas na infância, orientando às diferentes possibilidades diagnósticas. MATERIAIS E MÉTODOS: Foram realizados estudos tomográficos de lesões hipodensas hepáticas previamente diagnosticadas à ultra-sonografia em 50 pacientes pediátricos (0-16 anos). As imagens foram obtidas antes e após a administração de contraste venoso. Os aspectos de imagem foram analisados e correlacionados posteriormente com o diagnóstico anatomopatológico. RESULTADOS: Dos 50 casos estudados, 47 foram confirmados, 30 destes por estudo anatomopatológico. A maioria das lesões era benigna, sendo o hemangioma o mais freqüente (20% dos casos). Tais lesões apresentaram captação homogênea do meio de contraste, principalmente na fase tardia, diferenciando assim das malignas. As lesões malignas mais freqüentes foram as metástases (18%). CONCLUSÃO: O presente estudo constatou que o exame tomográfico, antes e após a administração do contraste venoso, dinâmico e/ou helicoidal, foi de grande valia para a complementação da hipótese diagnóstica nas lesões hipodensas hepáticas na infância, devendo ser rotina após diagnóstico ultra-sonográfico.
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Lauwers GY, Grant LD, Donnelly WH, Meloni AM, Foss RM, Sanberg AA, Langham MR. Hepatic undifferentiated (embryonal) sarcoma arising in a mesenchymal hamartoma. Am J Surg Pathol 1997; 21:1248-54. [PMID: 9331300 DOI: 10.1097/00000478-199710000-00018] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report the case of a hepatic undifferentiated (embryonal) sarcoma (UES) arising within a mesenchymal hamartoma (MH) in a 15-year-old girl. Mapping of the tumor demonstrated a typical MH transforming gradually into a UES composed of anaplastic stromal cells. When evaluated by flow cytometry, the MH was diploid and the UES showed a prominent aneuploid peak. Karyotypic analysis of the UES showed structural alterations of chromosome 19, which have been implicated as a potential genetic marker of MH. The histogenesis of MH and UES is still debated, and reports of a relationship between them, although suggested on the basis of histomorphologic similarities, have never been convincing. The histologic, flow cytometric, and cytogenetic evidence reported herein suggests a link between these two hepatic tumors of the pediatric population.
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Affiliation(s)
- G Y Lauwers
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Gainesville 32610, USA
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Stocker JT, Ishak KG. Mesenchymal hamartoma of the liver: report of 30 cases and review of the literature. PEDIATRIC PATHOLOGY 1983; 1:245-67. [PMID: 6687279 DOI: 10.3109/15513818309040663] [Citation(s) in RCA: 136] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Thirty cases of mesenchymal hamartoma of the liver are presented and compared with 42 previously published cases. The patients, 69% male, range in age from newborn to 10 years (average age 15 months, median age 10 months). Except for occasional cases in which the lesion is an incidental finding at autopsy, most present with progressive abdominal enlargement over a period of days to months. Physical and radiologic examinations are nonspecific except for the demonstration of a mass within or attached to the liver. The masses are large, averaging 1311 g, and frequently contain cysts filled with clear fluid or gelatinous material. Histologic examination shows a mixture of loose mesenchymal tissue, bile ducts, connective tissue, and hepatocytes along with cysts formed either from degenerative areas of mesenchyme or from dilated bile ducts and lympathics. Treatment is partial or total excision of the lesion. Mortality (7-17%) is related to intraoperative or postoperative complications. Recurrence or malignant transformation has not been noted.
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Abstract
Mesenchymal hamartoma of the liver is a rare benign tumor of childhood which has been confused with various other benign liver lesions, particularly vascular hamartomas which are mesodermal but not mesenchymal. The mass, frequently cystic, is characterized by an admixture of epithelial structures in a loose connective tissue stroma with fluid accumulation suggestive of lymphangiomatous channels. Four patients are presented and reviewed with 25 previously reported cases. The patients, usually asymptomatic, present during the first two years of life with progressive abdominal distention, which may be rapid because of increasing fluid content in the connective tissue stroma and cysts. Exploration and biopsy may be necessary before definitive excision. The present cases include a newborn, the youngest known, and a case in which radiation resulted in hyalinization of the mesenchyme, decrease in fluid content, and easlier resection. Respiratory distress and signs of vena caval obstruction due to intra-abdominal pressure were noted. Prognosis after extirpation is very good.
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