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Fenn D, Fung KFK, Liu APY, Ng WF, Kan YLE. Paediatric hepatic angiosarcoma with consumptive hypothyroidism-an important diagnostic pitfall to avoid during evaluation of hepatic vascular tumours. Pediatr Radiol 2024; 54:1040-1048. [PMID: 38580747 DOI: 10.1007/s00247-024-05915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024]
Abstract
Hepatic angiosarcoma is an extremely rare primary malignant vascular tumour in children with very poor prognosis. Radiological diagnosis of hepatic angiosarcoma is challenging due to overlapping imaging features with other benign vascular hepatic tumours, particularly infantile hepatic haemangioma. Consumptive hypothyroidism is a condition that is almost exclusively associated with infantile hepatic haemangioma and has never been reported in angiosarcoma. We present a case of hepatic angiosarcoma in a 20-month-old girl, associated with consumptive hypothyroidism and, as a result, initially misdiagnosed as infantile hepatic haemangioma. Radiologists should be aware that consumptive hypothyroidism is not a reliable feature to use in excluding paediatric hepatic angiosarcoma. Biopsy should be performed in patients older than 1 year of age or with atypical imaging features.
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Affiliation(s)
- Dickson Fenn
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Kowloon Bay, Hong Kong
| | - Kin Fen Kevin Fung
- Department of Radiology, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong.
| | - Anthony Pak-Yin Liu
- Division of Paediatric Haematology and Oncology, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
| | - Wai Fu Ng
- Department of Pathology, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
| | - Yee-Ling Elaine Kan
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Kowloon Bay, Hong Kong
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2
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Carney BW, Larson MC, Corwin MT, Lamba R. Imaging of Hepatobiliary Cancer. Curr Probl Cancer 2023:100964. [PMID: 37321910 DOI: 10.1016/j.currproblcancer.2023.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
The liver and biliary tree are common sites of primary and secondary malignancies. MRI followed by CT is the mainstay for the imaging characterization of these malignancies with the dynamically acquired contrast enhanced phases being the most important for diagnosis. The liver imaging reporting and data system classification provides a useful framework for reporting lesions in patents with underlying cirrhosis or who are at high risk for developing hepatocellular carcinoma. Detection of metastases is improved with the use of liver specific MRI contrast agents and diffusion weighted sequences. Aside from hepatocellular carcinoma, which is often diagnosed noninvasively, other primary hepatobiliary tumors may require biopsy for definite diagnosis, especially when presenting with nonclassic imaging findings. In this review, we examine the imaging findings of common and less common hepatobiliary tumors.
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Affiliation(s)
- Benjamin W Carney
- Department of Radiology, University of California, Davis Health System, Sacramento, California.
| | - Michael C Larson
- Department of Radiology, University of California, Davis Health System, Sacramento, California
| | - Michael T Corwin
- Department of Radiology, University of California, Davis Health System, Sacramento, California
| | - Ramit Lamba
- Department of Radiology, University of California, Davis Health System, Sacramento, California
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3
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Lin Y, Chen Z, Yang J, Lin Y, Chen S, Xie Y, Wu S. Advanced diffuse hepatic angiosarcoma treated successfully with TACE and targeted immunotherapy: A case report. Front Oncol 2023; 13:1071403. [PMID: 37152029 PMCID: PMC10157244 DOI: 10.3389/fonc.2023.1071403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Primary hepatic angiosarcoma (PHA), a rare soft tissue tumor, accounts for only 2% of all liver malignancies. Pathologically challenging, PHA is difficult to be distinguished from other malignancies with ultrasound, Computed Tomography (CT), or Magnetic Resonance Imaging (MRI). Due to late diagnosis and resistance against traditional chemotherapy and/or radiotherapy, only 3% of PHA patients can survive up to two years after diagnosis. To our best knowledge, this case report presents the first case of an advanced diffuse PHA with ruptured hemorrhage that has been effectively treated with TACE and Anlotinib plus Camrelizumab. So far, the patient has received 10 cycles of treatment and is faring well. Latest MRI results show that the tumor has shrunk by 56% and can be assessed as a partial response (PR). This case report includes our experience in treating such a advanced malignancy, and we hope that larger studies on advanced PHA can better quantify the potential benefit.
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Affiliation(s)
- Yucheng Lin
- Department of Ultrasonography, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Shengli Clinical Medical College, Fuzhou, China
| | - Zheng Chen
- Department of Oncology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jianchuan Yang
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ying Lin
- Department of Pathology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ying Xie
- Department of Hematology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Songsong Wu, ; Ying Xie,
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Songsong Wu, ; Ying Xie,
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Zhou L, Li SY, Chen C, Xu J. Hemorrhagic shock after contrast-enhanced ultrasound-guided liver biopsy: A case report of primary hepatic angiosarcoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:698-702. [PMID: 34964135 DOI: 10.1002/jcu.23114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/15/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Primary hepatic angiosarcoma (PHA) is a rare, highly aggressive malignancy. There is no specificity in clinical manifestations, laboratory examinations and imaging examinations. The definitive diagnosis of PHA depends on pathological analysis. The gold standard method to obtain specimens is percutaneous transhepatic biopsy under the guidance of contrast-enhanced ultrasound (CEUS). However, CEUS-guided biopsy for PHA is controversial. If a biopsy is necessary, a comprehensive preoperative evaluation is essential. In addition, CEUS has an auxiliary value in diagnosing PHA. In this case, we present an elderly woman who underwent CEUS-guided liver mass biopsy. The patient developed hemorrhagic shock after biopsy.
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Affiliation(s)
- Ling Zhou
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Shi-Yan Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Chao Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jing Xu
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
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Bhaludin BN, Thway K, Adejolu M, Renn A, Kelly-Morland C, Fisher C, Jones RL, Messiou C, Moskovic E. Imaging features of primary sites and metastatic patterns of angiosarcoma. Insights Imaging 2021; 12:189. [PMID: 34921641 PMCID: PMC8684573 DOI: 10.1186/s13244-021-01129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/14/2021] [Indexed: 12/14/2022] Open
Abstract
Angiosarcomas are rare, aggressive soft tissue sarcomas originating from endothelial cells of lymphatic or vascular origin and associated with a poor prognosis. The clinical and imaging features of angiosarcomas are heterogeneous with a wide spectrum of findings involving any site of the body, but these most commonly present as cutaneous disease in the head and neck of elderly men. MRI and CT are complementary imaging techniques in assessing the extent of disease, focality and involvement of adjacent anatomical structures at the primary site of disease. CT plays an important role in the evaluation of metastatic disease. Given the wide range of imaging findings, correlation with clinical findings, specific risk factors and patterns of metastatic disease can help narrow the differential diagnosis. The final diagnosis should be confirmed with histopathology and immunohistochemistry in combination with clinical and imaging findings in a multidisciplinary setting with specialist sarcoma expertise. The purpose of this review is to describe the clinical and imaging features of primary sites and metastatic patterns of angiosarcomas utilising CT and MRI.
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Matsui T, Nojima S, Morii E. Deep Vein Thrombosis as an Initial Symptom of Malignant Tumor: A Case Report of Angiosarcoma in the Iliac Vein. Case Rep Oncol 2021; 14:1542-1547. [PMID: 34899249 PMCID: PMC8613607 DOI: 10.1159/000519598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
Although deep vein thrombosis, as well as subsequent pulmonary embolism, is one of the major and fatal complications in cases of malignant neoplasm, it most often occurs after the diagnosis or treatment of the tumor. On the other hand, malignant tumors that develop with deep vein thrombosis as a specific initial symptom are extremely rare. Here, we report a case of angiosarcoma of the iliac vein, whose initial symptom was dyspnea due to pulmonary embolism. Although angiosarcoma arising directly from major blood vessels is rare, literature reviews, as well as our case, indicate that thromboembolism is an important initial symptom related to angiosarcoma from thick blood vessels and may contribute to immediate diagnosis and therapeutic intervention.
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Affiliation(s)
- Takahiro Matsui
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nojima
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
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Dogeas E, Mokdad AA, Bhattatiry M, Porembka MR, Polanco PM, Mansour JC, Choti MA, Augustine MM. Tumor Biology Impacts Survival in Surgically Managed Primary Hepatic Vascular Malignancies. J Surg Res 2021; 264:481-489. [PMID: 33857792 DOI: 10.1016/j.jss.2021.02.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/29/2021] [Accepted: 02/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatic angiosarcoma (AS) and hepatic epithelioid hemangioendothelioma (HEHE) are rare primary hepatic vascular malignancies (PHVM) that remain poorly understood. To guide management, we sought to identify factors and trends predicting survival after surgical intervention using a national database. MATERIALS AND METHODS In a retrospective analysis of the National Cancer Database patients with a diagnosis of PHVM were identified. Clinicopathologic factors were extracted and compared. Overall survival (OS) was estimated and predictors of survival were identified. RESULTS Three hundred ninty patients with AS and 216 with HEHE were identified. Only 16% of AS and 36% of HEHE patients underwent surgery. The median OS for patients who underwent surgical intervention was 97 months, with 5-year OS of 30% for AS versus 69% for HEHE patients (P< 0.001). Tumor biology strongly impacted OS, with AS histology (Hazard Ratio [HR] of 3.61 [1.55-8.42]), moderate/poor tumor differentiation (HR = 3.86 [1.03-14.46]) and tumor size (HR = 1.01 [1.00-1.01]) conferring worse prognosis. The presence of metastatic disease in the surgically managed cohort (HR = 5.22 [2.01-13.57]) and involved surgical margins (HR = 3.87 [1.59-9.42]), were independently associated with worse survival. CONCLUSIONS In this national cohort of PHVM, tumor biology, in the form of angiosarcoma histology, tumor differentiation and tumor size, was strongly associated with worse survival after surgery. Additionally, residual tumor burden after resection, in the form of positive surgical margins or the presence of metastasis, was also negatively associated with survival. Long-term clinical outcomes remain poor for patients with the above high-risk features, emphasizing the need to develop effective forms of adjuvant systemic therapies for this group of malignancies.
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Affiliation(s)
- Epameinondas Dogeas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ali A Mokdad
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mitu Bhattatiry
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew R Porembka
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John C Mansour
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael A Choti
- Department of Surgery, Banner MD Anderson Cancer Center, Phoenix, Arizona
| | - Mathew M Augustine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; North Texas Veterans Affairs Medical Center, Dallas, Texas.
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Chernyak V, Horowitz JM, Kamel IR, Arif-Tiwari H, Bashir MR, Cash BD, Farrell J, Goldstein A, Grajo JR, Gupta S, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Liver Lesion-Initial Characterization. J Am Coll Radiol 2020; 17:S429-S446. [PMID: 33153555 DOI: 10.1016/j.jacr.2020.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023]
Abstract
Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | | | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association
| | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | - Samir Gupta
- Rush University Medical Center, Chicago, Illinois; American College of Surgeons
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Tian G, Kong D, Jiang T, Li L. Complications After Percutaneous Ultrasound-Guided Liver Biopsy: A Systematic Review and Meta-analysis of a Population of More Than 12,000 Patients From 51 Cohort Studies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1355-1365. [PMID: 31999005 DOI: 10.1002/jum.15229] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/08/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Percutaneous liver biopsy (LB) has been considered the reference standard in distinguishing the degree of liver disease, but there has been no definitive systematic review to assess complication rates or potential risk factors for them. METHODS In this study, we searched the PubMed, Embase, Web of Science, and Scopus databases for studies appraising complication rates after percutaneous ultrasound (US)-guided LB published until October 11, 2018. The safety and efficacy of US-guided LB were estimated according to major and minor complications. Subgroups including the biopsy style, needle styles, mean number of needle insertions, study period, and specific complication items were analyzed. RESULTS Among 12,481 patients from 51 studies, pooled results showed a low rate (0; 95% confidence interval, 0-0) of major and minor complications. The subgroup analysis indicated that US-guided LB had a low major complication rate of 0 (0-0) for both fine-needle aspiration and core biopsy, with rates of 0.016 (0-0.032) for 14-gauge, 0.010 (0.003-0.017) for 15-gauge, 0.002 (-0.001-0.005) for 20-gauge, and 0 (0-0) for 16-, 17-, 18-, 21-, and 22-gauge needles, and low minor complication rates of 0 (0-0) for fine-needle aspiration and 0.001 (0-0.002) for core biopsy, with rates of 0.164 (0.137-0.191) for 15-gauge, 0.316 (0.113-0.519) for 16-gauge, and 0 (0-0) for 14-, 17-, 18-, 20-, 21-, and 22-gauge needles. Furthermore, specific complication rates of bleeding, pain, pneumothorax, vasovagal reactions, and death were all 0 (0-0). CONCLUSIONS These findings suggest that it is possible to safely perform percutaneous US-guided LB.
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Affiliation(s)
- Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dexing Kong
- Department of Mathematics, Zhejiang University, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumors of Zhejiang Province, Hangzhou, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Rujeerapaiboon N, Wetwittayakhlang P. Primary Hepatic Angiosarcoma: A Rare Liver Malignancy - Varying Manifestations but Grave Prognosis. Case Rep Gastroenterol 2020; 14:137-149. [PMID: 32355483 PMCID: PMC7184854 DOI: 10.1159/000506928] [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: 01/09/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022] Open
Abstract
Primary hepatic angiosarcoma (PHA) is a rare mesenchymal liver tumor, accounting for 0.1–2% of primary liver malignancies. The clinical presentations of PHA are variable, from asymptomatic to liver failure or complicated with tumor rupture. The diagnosis of PHA is difficult due to the lack of specific clinical manifestation and investigation results, which can be confused with other liver tumors resulting in late diagnosis. However, there is currently a paucity of effective therapeutic approaches. We advocate early diagnosis with radiological imaging and histopathology because most of them are diagnosed in late-stage and carry a grave prognosis. Surgical resection remains the mainstay of treatment, which can significantly prolong survival. Chemotherapy, including transarterial chemoembolization, is an option for palliative treatment. Unfortunately, molecular treatment has limited efficacy and liver transplantation is also not recommended due to high rate of recurrence. We present a case series of four patients with biopsy-proven PHA which had distinct presentations and clinical courses.
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Affiliation(s)
- Natthapat Rujeerapaiboon
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Panu Wetwittayakhlang
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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