1
|
Luong TTV, Mitchell C, Lokan J, Ng J, Lewin J. Long-Term Survival in an Adolescent and Young Adult with Metastatic Relapse of an Undifferentiated Embryonal Sarcoma of the Liver. J Adolesc Young Adult Oncol 2024. [PMID: 38579156 DOI: 10.1089/jayao.2023.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is an extremely rare and aggressive malignancy in adults.1 Adults with UESL have a worse prognosis compared to pediatric population.2 Due to the rarity of this disease in adults, there has been a lack of information that assists in treatment decisions within this group. Improved understanding of UESL in adults might assist in understanding biological differences compared to pediatric cohorts as well as tailor treatments to improve their overall outcome. We described the management and outcome of a young adult managed at our center with metastatic relapsed UESL. For comparison, a PubMed search for adolescent and young adult (AYA) and adults with UESL was performed with the aim to review and address any distinct clinical features, different aspects of management and survival outcomes within this population. A 21-year-old male underwent right hepatectomy for a large 16 cm localized UESL with clear surgical margin and did not receive adjuvant chemotherapy. Seven months postsurgery, he relapsed with both local and metastatic disease and underwent chemotherapy with vincristine, doxorubicin, cyclophosphamide alternating with ifosfamide and etoposide achieving a complete metabolic response. This was followed by Stereotactic Ablative Radiation Therapy and surgical resection of residual disease. He remains free of disease 3 years since his diagnosis. We subsequently reviewed 42 AYA and adults (aged >15) with UESL (median age, 33 years) between 1991 and 2022. Most patients presented with localized UESL and for those treated with surgery alone, 67% developed recurrences. Those receiving multimodality treatment, better outcomes, and reduced relapse rate was achieved. Twenty-seven patients developed recurrences, 13 with local recurrences and 14 with metastatic relapse. The median time to relapse was 12 months. We reported a successful outcome in multimodality treatment which resulted in long remission in a young adult with relapsed UESL. Combination of perioperative chemotherapy with locoregional treatment is important to improve long-term survival in adults with metastatic UESL.
Collapse
Affiliation(s)
- Thi Thao Vi Luong
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, Austin Health, Melbourne, Australia
| | - Catherine Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Julie Lokan
- Department of Oncology, Austin Health, Melbourne, Australia
| | - Jessica Ng
- Department of Anatomical Pathology, Royal Children Hospital, Melbourne, Australia
| | - Jeremy Lewin
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Victorian Adolescent and Young Adult Cancer Service, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
2
|
Suárez A, Suaza Vallejo MC, Brito J, Luengas JP, Mesa J. Undifferentiated Embryonal Sarcoma of the Liver in Pediatrics: A Diagnostic Challenge With Implications for Early Management. Cureus 2023; 15:e44923. [PMID: 37814737 PMCID: PMC10560589 DOI: 10.7759/cureus.44923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
A 10-year-old boy was evaluated for intermittent colicky abdominal pain, general malaise, and asthenia. Imaging revealed a solid liver lesion. Subsequent biopsy and extension studies diagnosed the lesion as undifferentiated embryonal sarcoma of the liver, classified as PRETEXT II, group III according to the postoperative staging system of the Intergroup Study for Soft Tissue Sarcomas. He underwent neoadjuvant chemotherapy using alternating cycles of ifosfamide, doxorubicin, vincristine, D-actinomycin, and cyclophosphamide. This was followed by surgical intervention and two additional adjuvant chemotherapy cycles, resulting in a complete disease response. The patient remains in follow-up and shows no signs of relapse 28 months post-diagnosis. Undifferentiated embryonal sarcoma of the liver is a rare and often misdiagnosed condition that can be mistaken for a benign disease. Its prognosis hinges on timely and accurate diagnosis, which is essential for effectively treating patients with this aggressive pathology with a high mortality risk. Notably, there is no standard treatment approach. In our case, we implemented therapeutic strategies from various literature reports, yielding a promising outcome and positive patient progression.
Collapse
Affiliation(s)
- Amaranto Suárez
- Pediatric Oncology, Instituto Nacional de Cancerología, Bogotá, COL
| | | | - Javier Brito
- Pediatric Oncology, Instituto Nacional de Cancerología, Bogota, COL
| | - Juan Pablo Luengas
- Hematology and Oncology, Instituto Nacional de Cancerología, Bogota, COL
| | - Jorge Mesa
- Pathology, Instituto Nacional de Cancerología, Bogotá, COL
| |
Collapse
|
3
|
Vergara R, Khalil S, Munene G. Case report: Multimodal neoadjuvant and adjuvant chemotherapy for hepatic undifferentiated embryonal sarcoma in a young adult. Front Oncol 2022; 12:1004108. [DOI: 10.3389/fonc.2022.1004108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 11/21/2022] Open
Abstract
Hepatic undifferentiated embryonal sarcoma of the liver (UESL) is a rare hepatic malignancy found more commonly in pediatric patients. It has been associated with poor outcomes in adults and the role and timing of systemic therapy is unclear. There have been very few case reports detailing combination neoadjuvant and adjuvant chemotherapy use for hepatic undifferentiated embryonal sarcoma in adults. In this report, a 22-year-old male admitted with right upper quadrant pain was diagnosed with a 20 x 10 x 10 cm well-circumscribed, highly vascularized hepatic mass in the entirety of the left lobe. Biopsy confirmed the diagnosis of UESL. PET/CT showed no evidence of metastatic disease, and he received four cycles of Doxorubicin and Ifosfamide with demonstrated reduction in size and decrease in PET avidity. He underwent left hepatectomy with periportal lymphadenectomy, cholecystectomy, and partial gastrectomy with negative margins and received adjuvant Doxorubicin, Ifosfamide and Mesna. At 48 months, the patient was alive without evidence of disease. We hereby emphasize the potential advantages of combination chemotherapy and surgical resection in the management of UESL in adults.
Collapse
|
4
|
Undifferentiated Embryonal Sarcoma of the Liver Involving All Major Hepatic Veins Treated by Left Extended Trisectionectomy. Case Rep Surg 2022; 2022:9673901. [PMID: 35677852 PMCID: PMC9170397 DOI: 10.1155/2022/9673901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/30/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Over the past few years, liver surgery has been in constant evolution and gained many improvements that helped surgeons push limits further. A complex procedure such as left extended trisectionectomy, as described by Makuuchi in 1987, may be performed in selected cases. Aim Describe a case of successful resection of a huge bilobar liver sarcoma involving all hepatic veins from a young female patient, in which the blood outflow was preserved through an inferior right hepatic vein, leaving only segment 6 as liver remnant. Case Report. A 19-year-old female with a 3-month history of abdominal pain, vomiting, and weight loss was referred for our evaluation. CT scan and MRI revealed a heterogeneous and bulky expansive hepatic lesion, sparing only segment 6, with an estimated volume of 530 cm3, corresponding to a 1.2 FLR/BW ratio. The tumor involved the three major hepatic veins, but an inferior right hepatic vein was present, draining the spared segment 6. She was submitted to a left trisectionectomy extended to the caudate lobe and segment 7, including resection of all hepatic veins and lymphadenectomy of the hepatic pedicle. She was discharged on the 7th postoperative day without complications. The histopathological and immunohistochemical analysis demonstrated an undifferentiated embryonal sarcoma of the liver. Conclusion Inferior right hepatic vein-preserving left extended trisectionectomy is a safe and feasible procedure that should be performed by a hepatobiliary team experienced in major complex hepatectomies.
Collapse
|
5
|
Clinicopathological study of hepatic mesenchymal hamartoma and undifferentiated embryonal sarcoma of the liver: a single center study from Iran. Diagn Pathol 2021; 16:55. [PMID: 34162402 PMCID: PMC8223305 DOI: 10.1186/s13000-021-01117-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/10/2021] [Indexed: 12/04/2022] Open
Abstract
Background Undifferentiated embryonal sarcoma of liver (UESL) and hepatic mesenchymal hamartoma (HMH) are two rare entities which mainly affect the pediatric population. The aim of this investigation was to provide a comprehensive overview of the clinicopathologic characteristics of the patients diagnosed with these two conditions in a tertiary referral center in Iran. Methods In this retrospective study patients diagnosed with UESL or HMH between 2012 and 2020 were studied. A comprehensive histopathologic evaluation of the cases along with immunohistochemistry evaluation using a panel of antibodies was conducted. Furthermore, clinical, paraclinical, and treatment data and follow up information was collected. Results A total of 16 patients (8 UESL, 8 HMH) were studied in this investigation. Patients with UESL had a significantly (p = 0.002) higher age at diagnosis compared with those with HMH. Histologically, UESL cases were characterized by anaplastic cells with eosinophilic cytoplasm and bizarre nuclei and frequent atypical mitosis and spindling in a myxoid stroma while disordered arrangement of hepatic parenchyma, bile ducts, and primitive mesenchyme was seen in HMH. Furthermore, small round cells and extramedullary hematopoiesis were seen in 2 UESL and 3 HMH cases, respectively. Concurrent HMH was also seen in two UESL cases. Immunohistochemistry panel showed positive staining for Vimentin, Glypican-3, Desmin, CD56, CD10, and BCL2 in UESL cases and immunoreactivity for Vimentin, HepPar 1, Glypican-3, SMA, CD56, BCL2, and CD34 in various components of HMH. Conclusions In this study, the clinicopathologic features of UESL and HMH cases are presented. We also evaluated the utility of an immunohistochemistry panel in the diagnosis of these two rare entities and suggested novel markers. Our study corroborated the findings of previous investigations and expanded the clinicopathologic features of these two rare entities with diagnostic and potential therapeutic implications.
Collapse
|
6
|
Kim SJ, Rhu J, Kim JM, Choi GS, Joh JW. Surgical treatment outcomes of primary hepatic sarcomas: A single-center experience. World J Hepatol 2021; 13:584-594. [PMID: 34131472 PMCID: PMC8173340 DOI: 10.4254/wjh.v13.i5.584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/24/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary hepatic sarcoma is a rare tumor originated from mesenchymal tissue. There are various pathologic types of primary hepatic sarcoma and the treatment outcome of this tumor was usually disappointing. Unlike hepatocellular carcinoma, outcome of primary hepatic sarcoma is not well-known due to it’s rarity. However, with development of medical technology, surgical treatment may lead to better survival.
AIM To investigate the surgical outcomes of primary hepatic sarcoma, we gathered and analyzed the cases of a single institute.
METHODS From August 2001 to September 2016, a total of nine patients were surgically treated for primary hepatic sarcoma after exclusion of cases with open and closure, early loss to follow-up and sarcomatoid hepatocellular carcinoma and sarcomatoid cholangiocellular carcinoma. Baseline characteristics, tumor characteristics such as tumor pathology, size and number, surgical and adjuvant treatments were reviewed. Tumor recurrence, and patient survival were analyzed with retrospective approach.
RESULTS The enrolled participants included five patients with angiosarcoma and four patients with undifferentiated sarcoma. All patients experienced tumor recurrence at a median of 52 post-operative days. Only two patients survived and the 5-year survival rate was 29.6%. One patient with angiosarcoma who received central hepatectomy for primary tumor and received radiofrequency ablation for recurrent tumor still lives for 11 years. One patient with undifferentiated sarcoma received Rt. lobectomy for primary tumor followed by chemotherapy and radiation therapy still lives around 30 mo even though she got additional operation for recurrent tumor. Two patients who received living donor liver transplantation due to angiosarcoma died. Only adjuvant therapy was associated with survival gain (P = 0.002).
CONCLUSION Patients with primary hepatic sarcoma may gain survival benefit with surgical resection followed by adjuvant therapy, even though the outcome remains relatively poor.
Collapse
Affiliation(s)
- Sang Jin Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea, Division of Hepatobiliopancreas and Transplant Surgery, Korea University Ansan Hospital, Ansan 15355, South Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Seoul 06351, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Seoul 06351, South Korea
| | - Gyu Seung Choi
- Department of Surgery, Samsung Medical Center, Seoul 06351, South Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Seoul 06351, South Korea
| |
Collapse
|
7
|
Zhang C, Jia CJ, Xu C, Sheng QJ, Dou XG, Ding Y. Undifferentiated embryonal sarcoma of the liver: Clinical characteristics and outcomes. World J Clin Cases 2020; 8:4763-4772. [PMID: 33195644 PMCID: PMC7642548 DOI: 10.12998/wjcc.v8.i20.4763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Undifferentiated embryonal sarcoma of the liver (UESL) is a rare liver malignancy originating from primary mesenchymal tissue. The clinical manifestations, laboratory tests, and imaging examinations of the disease lack specificity and the preoperative misdiagnosis rate is high. The overall prognosis is poor and survival rate is low.
AIM To investigate the diagnosis, treatment, and prognosis of UESL.
METHODS We performed a retrospective, single-center cohort study in Shengjing Hospital of China Medical University, which is a central hospital in northeast China. From 2005 to 2017, we recruited 14 patients with pathologically confirmed UESL. We analyzed the clinical manifestations, laboratory tests, imaging examinations, pathological examinations, therapy, and prognosis of these patients.
RESULTS There were nine males and five females aged 2-60 years old included in the study. The major initial symptoms were abdominal pain (71.43%) and fever (57.14%). Preoperative laboratory tests revealed that seven patients had increased leukocyte levels, four showed a decrease in hemoglobin levels, seven patients had increased glutamyl transpeptidase levels, nine had increased lactate dehydrogenase levels, and three showed an increase in carbohydrate antigen 199. There was no difference in the rate of misdiagnosis in preoperative imaging examinations of UESL between adults and children (6/6 vs 5/8, P = 0.091). The survival rate after complete resection was 6/10, while that after incomplete resection was 0/4 (P = 0.040), suggesting that complete resection is important to improve survival rate. In total, five out of the eight children achieved survival. During the follow-up, the maximum survival time was shown to be 11 years and minimum survival time was 6 mo. Six adult patients relapsed late after surgery and all of them died.
CONCLUSION Preoperative imaging examination for UESL has a high misdiagnosis rate. Multidisciplinary collaboration can improve the diagnostic accuracy of UESL. Complete surgical resection is the first choice for treatment of UESL.
Collapse
Affiliation(s)
- Chong Zhang
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Chang-Jun Jia
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Can Xu
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Qiu-Ju Sheng
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Xiao-Guang Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Yang Ding
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| |
Collapse
|
8
|
Olivas-Mazón R, Martín-Cazaña M, Pérez-Mohand P, Garzón-Lorenzo L, Espino-Hernández M, Baro-Fernández M, Pérez-Alonso V. Tumor-induced osteomalacia in an adolescent with an undifferentiated embryonal sarcoma of the liver. Pediatr Blood Cancer 2020; 67:e28386. [PMID: 32383825 DOI: 10.1002/pbc.28386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/19/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Raquel Olivas-Mazón
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Martín-Cazaña
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Vanesa Pérez-Alonso
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
9
|
Shadhu K, Ramlagun D, Veeramootoo JS, Qin J, Xia Y. Paradoxical approach towards coexistence of hepatic cyst and liver sarcoma: A case report. Int J Surg Case Rep 2019; 63:94-96. [PMID: 31574457 PMCID: PMC6796639 DOI: 10.1016/j.ijscr.2019.09.018] [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: 05/12/2019] [Revised: 09/08/2019] [Accepted: 09/13/2019] [Indexed: 11/23/2022] Open
Abstract
Coexistence of hepatic cyst and liver sarcoma. Recurrence of hepatic cysts. Surgical approach has been mentioned as the treatment modality. The roles of chemotherapy and radiotherapy are still controversial.
Introduction Liver sarcoma is exceedingly rare and is a clinical challenge. Case report A 69-year-old female presented with right upper quadrant pain after a fall. Her CT scan showed multiple cysts. She was initially diagnosed as hepatic cysts with hemorrhage and underwent puncture and drainage of liver cysts. But the cysts relapsed quickly. Then she underwent fenestration of the hepatic cysts. The liver cysts reoccurred again accompanied by massive bleeding and obstructive jaundice. She underwent right trihepatectomy and her final pathological report showed liver sarcoma. However, the hepatic sarcoma reoccurred again. Its’ diagnosis and treatment process are extremely complex. In the end, she had a bad ending. Conclusion We believe that timely diagnosis and complete excision of liver sarcoma are very important.
Collapse
Affiliation(s)
- Kamleshsingh Shadhu
- Hepatobiliary Centre, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, Jiangsu, 210029, PR China; Medical Council of Mauritius, One Way Floreal Road, Cite Magalkhan, Floreal, Mauritius
| | - Dadhija Ramlagun
- Hepatobiliary Centre, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, Jiangsu, 210029, PR China; Medical Council of Mauritius, One Way Floreal Road, Cite Magalkhan, Floreal, Mauritius
| | - Jordee Selvamanee Veeramootoo
- Hepatobiliary Centre, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, Jiangsu, 210029, PR China
| | - Jianjie Qin
- Hepatobiliary Centre, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, Jiangsu, 210029, PR China.
| | - Yongxiang Xia
- Hepatobiliary Centre, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, Jiangsu, 210029, PR China
| |
Collapse
|
10
|
Plumblee L, Grey H, Hudspeth M, Nadig S. Undifferentiated embryonal sarcoma and the role of liver transplantation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
|
11
|
Mathias MD, Ambati SR, Chou AJ, Slotkin EK, Wexler LH, Meyers PA, Magnan H. A single-center experience with undifferentiated embryonal sarcoma of the liver. Pediatr Blood Cancer 2016; 63:2246-2248. [PMID: 27427850 PMCID: PMC5073002 DOI: 10.1002/pbc.26154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/24/2022]
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare aggressive mesenchymal pediatric tumor. Previously, reported outcomes have been very poor. Here, we report a single-center experience of five patients with UESL treated with upfront gross total resection and adjuvant chemotherapy. We have a median follow-up of 8 years with a range from 5 to 19 years with 100% event-free survival.
Collapse
Affiliation(s)
- Melissa D. Mathias
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center. New York City, New York,Correspondence to: Melissa Mathias, MD, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
| | - Srikanth R. Ambati
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center. New York City, New York
| | - Alexander J. Chou
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center. New York City, New York
| | - Emily K. Slotkin
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center. New York City, New York
| | - Leonard H. Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center. New York City, New York
| | - Paul A. Meyers
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center. New York City, New York
| | - Heather Magnan
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center. New York City, New York
| |
Collapse
|
12
|
Techavichit P, Masand PM, Himes RW, Abbas R, Goss JA, Vasudevan SA, Finegold MJ, Heczey A. Undifferentiated Embryonal Sarcoma of the Liver (UESL): A Single-Center Experience and Review of the Literature. J Pediatr Hematol Oncol 2016; 38:261-8. [PMID: 26925712 DOI: 10.1097/mph.0000000000000529] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive pediatric malignancy. The purpose of this study was to review the clinical, radiologic, and pathologic features and outcome of children with UESL at our institution, in the United Network of Organ Sharing database and to review the existing literature to define the state of the art for children with UESL. Six children were diagnosed with UESL at the Texas Children's Cancer Center between 1993 and 2014, 12 children underwent liver transplantation registered in the United Network of Organ Sharing database, and 198 children with UESL were described in 23 case series during 1978 to 2014. Patients were treated with multimodal treatment approaches including primary surgical resection, neoadjuvant and/or adjuvant chemotherapy, and liver transplantation resulting in overall survival reported between 20% and 100% with significant improvement over the recent years. We show that complete tumor removal remains the key element of treatment and our single-institutional experience and data in the published literature suggest that combination chemotherapy with ifosfamide and doxorubicin to facilitate complete surgical resection is an effective approach to cure children with UESL.
Collapse
Affiliation(s)
- Piti Techavichit
- *Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Departments of †Radiology ‡Pediatrics, Section Gastroenterology §Surgery ∥Pathology ¶Pediatrics, Section Hematology and Oncology, Baylor College of Medicine, Houston, TX
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Pugmire BS, Towbin AJ. Magnetic resonance imaging of primary pediatric liver tumors. Pediatr Radiol 2016; 46:764-77. [PMID: 27229495 DOI: 10.1007/s00247-016-3612-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/28/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
Although primary hepatic neoplasms are less common than other intra-abdominal tumors in children, these neoplasms are a significant source of morbidity and mortality in the pediatric population. MRI is increasingly relied upon in the diagnostic evaluation of these lesions, both before and after treatment, and familiarity with the MRI findings associated with these neoplasms is a must for pediatric radiologists. Advances in MRI technology, particularly the advent of hepatocyte-specific gadolinium-based MRI contrast agents, have allowed for accurate characterization of several types of hepatic neoplasms on the basis of imaging appearance. In this review, we provide an overview of the approach to imaging hepatic neoplasms in children using MRI, including a sample imaging protocol. We also discuss the relevant clinical features and MRI findings of the most clinically relevant entities, including their appearance on post-contrast imaging using hepatocyte-specific gadolinium-based MRI contrast agents.
Collapse
Affiliation(s)
- Brian S Pugmire
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA.
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Putra J, Ornvold K. Undifferentiated embryonal sarcoma of the liver: a concise review. Arch Pathol Lab Med 2015; 139:269-73. [PMID: 25611111 DOI: 10.5858/arpa.2013-0463-rs] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Undifferentiated embryonal sarcoma of the liver is an aggressive mesenchymal tumor that occurs predominantly in children. Although this entity has been described for decades, its pathogenesis is still obscure. Its association with mesenchymal hamartoma has been well described on the basis of identical chromosomal abnormalities. The clinical and radiological diagnoses are often difficult, and the diagnosis of undifferentiated embryonal sarcoma of the liver is based on its histology and immunophenotype. It is essential to recognize the characteristic histologic findings and the pattern of the immunohistochemistry staining to rule out other hepatic lesions. Multimodal therapy with surgery, chemotherapy, and radiation therapy has drastically improved the prognosis of patients with undifferentiated embryonal sarcoma of the liver. This successful management requires timely diagnosis for superior outcome.
Collapse
Affiliation(s)
- Juan Putra
- From the Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | |
Collapse
|
16
|
Wildhaber BE, Montaruli E, Guérin F, Branchereau S, Martelli H, Gauthier F. Mesenchymal hamartoma or embryonal sarcoma of the liver in childhood: a difficult diagnosis before complete surgical excision. J Pediatr Surg 2014; 49:1372-7. [PMID: 25148740 DOI: 10.1016/j.jpedsurg.2014.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/03/2014] [Accepted: 04/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Clinical experience shows that the primary diagnosis of mesenchymal hamartoma (MHL) and embryonal sarcoma of the liver (ESL) recurrently is mistaken, leading to inadequate managements. We evaluated the accuracy of the primary diagnosis of those liver tumors, compared with the final histological diagnosis. METHODS Records of 25 children (0-16 years, treated 01/1989-01/2013) with final diagnosis of MHL or ESL were analyzed. RESULTS Final diagnosis was MHL in 18/25 children (10 solid-cystic, 2 cystic, 6 solid) and ESL in 7/25 (4 solid-cystic, 1 cystic, 2 solid). Only 3/7 ESL patients and 15/18 MHL patients fell into the "typical" age group. In 13/25 children primary diagnosis was based on imaging only. Overall, primary diagnosis was concordant with the final diagnosis in 17/25 patients. Of 99/25 biopsied cases, 4/9 biopsy results exposed the wrong final diagnosis; of cystic-solid masses 4/14 were mistaken, of cystic masses 1/3, of solid masses 3/8. CONCLUSION Preoperative diagnosis of MHL and ESL is challenging because of atypical clinical presentation, misleading "typical" radiological findings, and difficult interpretation of biopsies. If feasible, complete surgical resection of, in particular, solid-cystic liver masses in the pediatric age group must be aimed for, to get a definitive, final diagnosis, followed by an adequate treatment strategy.
Collapse
Affiliation(s)
- Barbara E Wildhaber
- Hôpitaux Universitaires de Genève, Department of Pediatrics, Division of Pediatric Surgery, 6 Rue Willy Donzé, 1205 Geneva, Switzerland.
| | - Ernesto Montaruli
- Hôpitaux Universitaires de Genève, Department of Pediatrics, Division of Pediatric Surgery, 6 Rue Willy Donzé, 1205 Geneva, Switzerland
| | - Florent Guérin
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Sophie Branchereau
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Hélène Martelli
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Frédéric Gauthier
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| |
Collapse
|
17
|
He B, Xu K, Huang K, Huang Y, Li P, Chen Z, Shi H, Zhang Q, Shan Y. Undifferentiated embryonal liver sarcoma in childhood: A case report. Oncol Lett 2014; 8:1127-1132. [PMID: 25120671 PMCID: PMC4114632 DOI: 10.3892/ol.2014.2262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 04/16/2014] [Indexed: 12/27/2022] Open
Abstract
In order to improve the diagnosis and therapy of undifferentiated embryonal liver sarcoma (UELS), the present study presents the case of a 9-year-old female with UELS and discusses UELS in childhood. The patient presented with abdominal pain and fever. The laboratory tests, radiographic examination and pathological features presented by the female were similar to those of typical cases of UELS reported in childhood. The patient initially received surgical treatment and the immunohistochemical findings suggested that the patient had UELS. The patient’s parents refused adjuvant chemotherapy and demonstrated a right prerenal mass 6 months post-surgery. Microscopic examination revealed that the tumor was evidence of undifferentiated embryonal sarcoma recurrence. However, the patient was comfortable and physical examination revealed no abnormal conditions. In addition, the laboratory results were normal. Abdominal computed tomography scan and ultrasound were performed every 3 months to monitor the tumor recurrence. At the time of writing, it has been 6 months after the second surgical procedure and there has been no appearence of abnormalities. Previous studies have shown that patients who receive combined therapy with complete tumor resection and adjuvant chemotherapy have a longer survival time than those who undergo surgical therapy alone. Complete tumor resection combined with adjuvant chemotherapy may reduce the risk of recurrence and enhance the survival time in patients with UELS.
Collapse
Affiliation(s)
- Bin He
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Keyu Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Kate Huang
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yuehan Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Peng Li
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhenkun Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Hongqi Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Qiyu Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yunfeng Shan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| |
Collapse
|
18
|
Walther A, Geller J, Coots A, Towbin A, Nathan J, Alonso M, Sheridan R, Tiao G. Multimodal therapy including liver transplantation for hepatic undifferentiated embryonal sarcoma. Liver Transpl 2014; 20:191-9. [PMID: 24142883 DOI: 10.1002/lt.23773] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/16/2013] [Indexed: 12/14/2022]
Abstract
The outcomes of hepatic undifferentiated embryonal sarcoma (HUES) have historically been limited by persistent, unresectable disease and the subsequent development of disease resistance and dissemination. We present our institutional experience with HUES and assess current treatment trends and outcomes in the era of liver transplantation. We conducted a retrospective chart review of cases presenting with HUES at our institution over the past 10 years. The collected data included age, sex, presenting symptoms, imaging and the associated Pretreatment Extent of Disease (PRETEXT) score, pathology, chemotherapy, surgical interventions, and outcomes. Approval was obtained from the institutional review board of the Cincinnati Children's Hospital Medical Center. HUES was identified in 6 patients (4 males and 2 females) with a median age at diagnosis of 11 years (range = 7-13 years). Initial imaging was available for all but 1 patient. The PRETEXT stage for these patients ranged from II to III. One patient was diagnosed with lung metastases. Two patients underwent upfront resection, and 1 patient received neoadjuvant therapy and then conventional resection. Three patients were treated with orthotopic liver transplantation (OLT) after neoadjuvant chemotherapy (primary OLT in 2 cases and salvage OLT for local recurrence in 1 case). Two patients received posttransplant adjuvant chemotherapy. All 6 patients remained in clinical remission with a mean follow-up of 35 months (range = 12-84 months). In conclusion, OLT has rarely been reported as a treatment option for HUES. The addition of liver transplantation as a surgical option for treating patients with HUES can result in improved survival for patients whose tumors are initially unresectable or recur.
Collapse
Affiliation(s)
- Ashley Walther
- Departments of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE Embryonal sarcoma accounts for 6 % of liver tumors. This study reviews its features and the results of treatment in a referral center. METHODS We retrospectively reviewed liver tumors treated between 1995 and 2011. PRETEXT staging and biopsy were used to tailor chemotherapy according to SIOP protocols. Radical surgery was performed when possible. Complications and cumulative survival were the outcome endpoints. RESULTS Six out of 156 primary liver tumors (four males and two females) were sarcomas. The mean age at diagnosis was 81 ± 8.5 months. The most frequent finding was abdominal mass. Alfa-fetoprotein was normal. Imaging depicted heterogeneous tumors with septa, necrosis, and hemorrhagic areas. The diagnosis was ascertained by biopsy. Three tumors were located in the right lobe (PRETEXT II): two were bilobar (PRETEXT III) and one was in the left lobe (PRETEXT I). Two children had metastases at diagnosis and high-risk chemotherapy (vincristine, carboplatin, epirubicin) was administered with poor response. They died without operation 4 and 10 months later. Four patients with local disease underwent typical liver resections after chemotherapy (iphosphamide, vincristine, actinomycin D, and doxorrubicin). Overall actuarial survival at 70 months was 66.6 %. CONCLUSIONS Extended and metastatic embryonal sarcoma do poorly whereas localized tumors amenable to complete surgical removal after chemotherapy can cure.
Collapse
|
20
|
Jia C, Zhao W, Dai C, Wang X, Bu X, Peng S, Xu F, Xu Y, Zhao Y. Undifferentiated embryonal sarcoma of the liver in a middle-aged adult with systemic lupus erythematosus. World J Surg Oncol 2013; 11:244. [PMID: 24073982 PMCID: PMC3850891 DOI: 10.1186/1477-7819-11-244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 09/19/2013] [Indexed: 01/30/2023] Open
Abstract
Adult primary undifferentiated embryonal sarcoma of the liver (UESL) is a rare disease. While the etiology of UESL remains largely unknown, association with systemic inflammatory disorders has been observed. Here, we report a case of UESL in a 46-year-old woman with systemic lupus erythematosus (SLE) and without chronic hepatitis or liver cirrhosis. Systematic review of the publicly available English language medical literature identified only 27 cases of UESL in patients aged >45 years and none with SLE. Our patient presented with abdominal pain and had a 2-year history of SLE. Abdominal ultrasonography and enhanced computed tomography revealed a solid mass in the right lobe of the liver. Presumptive diagnosis of atypical hepatocellular carcinoma was made and the patient was treated with segmentectomy of S5 and S4a and cholecystectomy. The final diagnosis of UESL was made according to the pathology results. Since SLE patients may be at increased risk of malignancy, it is possible that the SLE pathogenesis may have contributed to the development of UESL in our patient. According to this case, UESL should be considered when SLE patients present with hepatic space-occupying lesions.
Collapse
Affiliation(s)
- Changjun Jia
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004 Liaoning Province, P R China
| | - Wei Zhao
- Department of Pathology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, P R China
| | - Chaoliu Dai
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004 Liaoning Province, P R China
| | - Xinlu Wang
- Department of Ultrasound Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, P R China
| | - Xianmin Bu
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004 Liaoning Province, P R China
| | - Songlin Peng
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004 Liaoning Province, P R China
| | - Feng Xu
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004 Liaoning Province, P R China
| | - Yongqing Xu
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004 Liaoning Province, P R China
| | - Yang Zhao
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004 Liaoning Province, P R China
| |
Collapse
|
21
|
Jia CJ, Zhao W, Dai CL. Diagnosis and treatment of undifferentiated embryonal sarcoma of the liver: A retrospective study of four cases. Shijie Huaren Xiaohua Zazhi 2013; 21:1327-1332. [DOI: 10.11569/wcjd.v21.i14.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
AIM: To explore the diagnosis and treatment of undifferentiated embryonal sarcoma of the liver (UESL).
METHODS: Clinical data for four patients with pathologically confirmed UESL who were treated at our hospital between 2005 and 2011 were retrospectively analyzed.
RESULTS: Three children (2 female and 1 male) and one female adult were included. Their age was 14, 14, 6 and 46 years old, respectively. Clinical presentation was typically an abdominal mass that may be accompanied by pain and/or fever. Diagnosis relies on histopathological examination and it is difficult for radiological examination to establish a definite diagnosis. Tumors were removed surgically in all four patients, and two patients received adjuvant chemotherapy.
CONCLUSION: UESL is an unusua1 malignancy of the 1iver. Whenever feasible, radica1 resection should be attempted as a part of combination modalities. Multiagent adjuvant chemotherapy and supportive therapy might improve surviva1.
Collapse
|