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Narayanan G, Spano A, Gentile NT, Shnayder-Adams MM, Gurusamy V, Levi DM, Wilky BA, Mora RA, Noman R, Peddu P, Dijkstra M. Irreversible Electroporation as a Valid Treatment Option for Hepatic Epithelioid Hemangioendothelioma: An International Multicenter Experience. Cardiovasc Intervent Radiol 2024; 47:883-890. [PMID: 38844684 PMCID: PMC11239779 DOI: 10.1007/s00270-024-03770-5] [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: 01/05/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Hepatic epithelioid hemangioendothelioma (HEHE) is a rare tumor with currently no established standard of care. This international multicenter retrospective study assesses the use of percutaneous irreversible electroporation (IRE) as an ablative tool to treat HEHE and provides a clinical overview of the current management and role of IRE in HEHE treatment. MATERIAL AND METHODS Between 2017 and 2023, 14 patients with 47 HEHE tumors were treated with percutaneous IRE using CT-scan guidance in 23 procedures. Baseline patient and tumor characteristics were evaluated. Primary outcome measures included safety and effectiveness, analyzed using Common Terminology Criteria for Adverse Events (CTCAE) and treatment response by mRECIST criteria. Secondary outcome measures included technical success, post-treatment tumor sizes and length of hospital stay. Technical success was defined as complete ablation with an adequate ablative margin (intentional tumor free ablation margin > 5 mm). RESULTS IRE treatment resulted in technical success in all tumors. Following a median follow-up of 15 months, 30 tumors demonstrated a complete response according to mRECIST criteria. The average tumor size pre-treatment was 25.8 mm, accompanied by an average reduction in tumor size by 7.5 mm. In 38 out of 47 tumors, there was no evidence of local recurrence. In nine tumors, residual tumor was present. There were no cases of progressive disease. Median length of hospital stay was one day. Only one grade 3 CTCAE event occurred, a pneumothorax requiring chest tube placement. CONCLUSION The current study provides evidence that IRE is a safe and efficacious minimally invasive treatment option for HEHE.
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Affiliation(s)
- Govindarajan Narayanan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anthony Spano
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Nicole T Gentile
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Michelle M Shnayder-Adams
- Division of Vascular and Interventional Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Varshana Gurusamy
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - David M Levi
- Division of Abdominal Transplant Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA
| | | | - Ronald A Mora
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Raihan Noman
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Praveen Peddu
- Department of Radiology, King's College Hospital NHS Trust, London, UK
| | - Madelon Dijkstra
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Luo L, Cai Z, Zeng S, Wang L, Kang Z, Yang N, Zhang Y. CT and MRI features of hepatic epithelioid haemangioendothelioma: a multi-institutional retrospective analysis of 15 cases and a literature review. Insights Imaging 2023; 14:2. [PMID: 36600110 DOI: 10.1186/s13244-022-01344-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To improve the current imaging understanding of MRI or CT for hepatic epithelioid haemangioendothelioma (HEHE) to aid in its successful preoperative diagnosis. METHODS The imaging features of 15 patients (median age 38.6, range 20-71; 7 M/8 F) from eight institutions with pathologically confirmed HEHE were retrospectively analysed. Additionally, the CT/MR imaging features of 180 patients in 15 literature publications were collected, analysed and compared with our case series. RESULTS Fifteen patients underwent CT and MRI (n = 2), CT (n = 9) or MR (n = 8) scans. A total of 92.9% (13/14) of the patients were initially diagnosed with other lesions on imaging. A total of 86.7% (13/15) were multifocal. Nodules (11/15, 73.3%) were predominantly peripheral in distribution (12/15, 80.0%). Some cases were associated with hepatic capsular retraction (13/15, 86.7%), "target signs" (8/15, 53.3%) and "lollipop signs" (5/15, 33.3%). Peripheral enhancement of various shapes in the early phase with a progressive centripetal filling was the most common pattern of enhancement (12/15, 80.0%). Abnormal vascularity was seen in 50.7% (6/15) of the patients. Suspicious tumour thromboses in the inferior vena cava were seen in 3 (20.0%) of the patients. Two of the 15 patients (13.3%) had a history of smoking. CONCLUSIONS HEHEs have common distinctive features, including multifocal lesions that are predominantly peripheral, "target signs", "lollipop signs", hepatic capsular retraction and peripheral enhancement of various shapes in the early phase with progressive centripetal filling. Additional aggressive imaging features that may be valuable clues to the diagnosis can be identified by CT or MRI.
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Affiliation(s)
- Lianmei Luo
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua Dong Road, Zhuhai, 519000, Guangdong, China
| | - Zeyu Cai
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua Dong Road, Zhuhai, 519000, Guangdong, China
| | - Sihui Zeng
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lizhu Wang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua Dong Road, Zhuhai, 519000, Guangdong, China
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ning Yang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Yaqin Zhang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua Dong Road, Zhuhai, 519000, Guangdong, China.
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Huda T, Parwez MM, Pandya B. Metastatic Hepatic Epitheloid Hemangioendothelioma in a Young Male: A Rare Presentation. Gastrointest Tumors 2021; 8:58-62. [PMID: 33981683 DOI: 10.1159/000513963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
Hepatic EHE (epithelioid hemangioendothelioma) is an uncommon entity of vascular origin and a low-grade malignant tumor. Primary hepatic EHE is rare. These tumors can be multifocal at presentation like in the soft tissues, bones, brain, liver, and small intestine. First described by Weiss and Enzinger in 1982 as a malignant vascular neoplasm with indolent behavior. We report the case of a 23-year-old male, known case of chronic liver disease, who presented with incisional hernia following exploratory laparotomy 8 months back, performed for intestinal obstruction. Contrast-enhanced computed tomography abdomen revealed an incisional hernia with a large defect along with multiple lesions in the liver (suspected metastases) and peritoneal deposits and a few discrete lung nodules. Some areas of interloop collections were also noted. Biopsies were taken from the liver which revealed benign cirrhotic lesion. Relevant to the findings, multiple biopsies were performed and fluid was sent for evaluation. The liver biopsy came out positive for borderline vascular malignancy (epithelioid hemangioendothelioma). This was confirmed with the immunohistochemistry report. Epithelioid hemangioendothelioma occurs mostly in soft tissues of extremity and lungs. The involvement of the liver may be seen as metastasis or rarely as a primary tumor. The incidence of primary malignant hepatic hemangioendothelioma is about 0.1/100,000; the mean age at the time of diagnosis is 41.7 years, and male:female ratio is 2:3. Liver transplantation, hepatectomy, chemoembolization, radiotherapy, and chemotherapeutic agents are reported treatment regimens. Malignant EHE of liver presents as multiple hepatic nodules. Being locally aggressive, it can invade the peritoneum, gut, and lungs. Orthoptic liver transplantation appears to be the only remedy because of the multifocal nature of the disease. Partial hepatectomy is possible for localized tumors.
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Affiliation(s)
- Tanweerul Huda
- Department of General Surgery, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Bharati Pandya
- Department of General Surgery, AIIMS, Bhopal, Madhya Pradesh, India
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Treska V, Daum O, Svajdler M, Liska V, Ferda J, Baxa J. Hepatic Epithelioid Hemangioendothelioma - a Rare Tumor and Diagnostic Dilemma. ACTA ACUST UNITED AC 2018; 31:763-767. [PMID: 28652454 DOI: 10.21873/invivo.11128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Hepatic epithelioid haemangio-endothelioma (HEHE) is a very rare malignant tumor of vascular origin and uncertain biological behaviour that is difficult to diagnose using preoperative radiology diagnostic techniques. PATIENTS AND METHODS The authors present here two patients with HEHE of different extent. The first patient had a generalised form of disease, with involvement of the liver, lungs and bones and was treated with a combination of bevacizumab and capecitabine. The second patient had a localised form of disease involving the liver and this was resolved using a combination of liver resection and radiofrequency ablation. In both patients, the radiology work-up before surgery was non-specific and metastases of another malignant process were considered. The definitive histological diagnosis was made by the pathologist on the basis of immunohistochemical analysis that demonstrated the presence of CD31, CD34 and calmodulin-binding transcription activator 1 (CAMTA 1). RESULTS Both patients remain in an overall good condition 27 and 5 months respectively following treatment for HEHE. CONCLUSION Preoperative radiological diagnosis of HEHE is difficult and immunohistochemical examination of the tumor tissue sample remains the key diagnostic tool. Radical surgical resection or liver transplantation is the method of choice in patients with localised liver involvement.
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Affiliation(s)
- Vladislav Treska
- Department of Surgery, Faculty of Medicine and Faculty Hospital Pilsen, Charles University Prague, Pilsen, Czech Republic
| | - Ondrej Daum
- Sikl's Institute of Pathology, Faculty of Medicine and Faculty Hospital Pilsen, Charles University Prague, Pilsen, Czech Republic
| | - Martin Svajdler
- Sikl's Institute of Pathology, Faculty of Medicine and Faculty Hospital Pilsen, Charles University Prague, Pilsen, Czech Republic
| | - Vaclav Liska
- Department of Surgery, Faculty of Medicine and Faculty Hospital Pilsen, Charles University Prague, Pilsen, Czech Republic
| | - Jiri Ferda
- Department of Radiodiagnostics, Faculty of Medicine and Faculty Hospital Pilsen, Charles University Prague, Pilsen, Czech Republic
| | - Jan Baxa
- Department of Radiodiagnostics, Faculty of Medicine and Faculty Hospital Pilsen, Charles University Prague, Pilsen, Czech Republic
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Lai Q, Feys E, Karam V, Adam R, Klempnauer J, Oliverius M, Mazzaferro V, Pascher A, Remiszewski P, Isoniemi H, Pirenne J, Foss A, Ericzon BG, Markovic S, Lerut JP. Hepatic Epithelioid Hemangioendothelioma and Adult Liver Transplantation: Proposal for a Prognostic Score Based on the Analysis of the ELTR-ELITA Registry. Transplantation 2017; 101:555-564. [PMID: 28212256 DOI: 10.1097/tp.0000000000001603] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor which has an intermediate aggressive behavior. Although the value of liver transplantation (LT) is well established, its place in the management of HEHE is still unclear. The aim of this study is to confirm, based on a very large patient cohort, the value of LT in the management of HEHE and to identify risk factors for post-LT recurrence. METHODS The outcome of 149 transplant recipients with HEHE recorded in the European Liver Transplant Registry during the period November 1984 to May 2014 was analyzed. Median post-LT follow-up was 7.6 years (interquartile range, 2.8-14.4). RESULTS Cox regression analysis showed that macrovascular invasion (hazard ratio [HR], 4.8; P < 0.001), pre-LT waiting time of 120 days or less (HR, 2.6; P = 0.01) and hilar lymph node invasion (HR = 2.2; P = 0.03), but not pre-LT extrahepatic disease, were significant risk factors for recurrence. These findings, which were also confirmed in a propensity score analysis, allowed the development of a HEHE-LT score enabling stratification of patients in relation to their risk of tumor recurrence. Patients with a score of 2 or less had a much better 5-year disease-free survival compared to those having a score of 6 or higher (93.9% vs 38.5%; P < 0.001). CONCLUSIONS The analysis of this (largest in the world) HEHE adult liver recipient cohort clearly confirms the value of LT in the treatment of this rare disorder and also permits identification of patients at risk of posttransplant recurrence. Posttransplant follow-up should take the HEHE-LT score into account. Extrahepatic disease localization is reconfirmed not to be a contraindication for LT.
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Affiliation(s)
- Quirino Lai
- 1 Starzl Abdominal Transplant Unit, University Hospitals St. Luc, Université catholique Louvain, Brussels, Belgium. 2 Centre Hépatobiliaire Paul Brousse, Paris, France. 3 Medizinsche Hochschule Hannover, Hannover, Germany. 4 Transplancenter IKEM, Prague, Czech Republic. 5 Istituto Nazionale Tumori, Milano, Italy. 6 Charité Campus Virchow Klinikum, Berlin, Germany. 7 Department of General Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland. 8 UCJ Helsingfors, Helsinki, Finland. 9 Department Abdominal transplantation Surgery, Universitaire Ziekenhuizen Gasthuisberg KULeuven, Belgium. 10 Rikshospitalet, Oslo Universitetssykehus, Oslo, Norway. 11 Karolinska University Hospital, Huddinge, Stockholm, Sweden. 12 University Medical Centre Ljubljana, Ljubljana, Slovenia
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Wang Q, Huang HF, Li ZT, Zhao XR, Duan J, Lin J, Xia ZC, Zeng Z. Diagnosis and treatment of hepatic perivascular epithelioid cell tumor: A case report and literature review. Shijie Huaren Xiaohua Zazhi 2016; 24:4315-4318. [DOI: 10.11569/wcjd.v24.i31.4315] [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
Liver perivascular epithelioid cell tumor is a rare liver mesenchymal tumor with an insidious onset. This entity is often misdiagnosed due to the lack of typical clinical symptoms and signs and the low diagnosis rate achieved by imaging examinations. Here we report a case of liver perivascular epithelioid cell tumor. We also performed a literature review to summarize and analyze the clinical characteristics and treatment of this disease.
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Hu HJ, Jin YW, Jing QY, Shrestha A, Cheng NS, Li FY. Hepatic epithelioid hemangioendothelioma: Dilemma and challenges in the preoperative diagnosis. World J Gastroenterol 2016; 22:9247-9250. [PMID: 27895413 PMCID: PMC5107607 DOI: 10.3748/wjg.v22.i41.9247] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/09/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare category of vascular tumor with uncertain malignant potential. It commonly presents nonspecific and variable clinical manifestations, ranging from asymptomatic to hepatic failure. In addition, laboratory measurements and imaging features also lack specificity in the diagnosis of HEHE. The aim of the present study is to highlight the dilemma and challenges in the preoperative diagnosis of HEHE, and to enhance awareness of the range of hepatobiliary surgery available in patients with multiple hepatic nodular lesions on imaging. In these patients, HEHE should at least be considered in the differential diagnosis.
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Dong Y, Wang WP, Cantisani V, D’Onofrio M, Ignee A, Mulazzani L, Saftoiu A, Sparchez Z, Sporea I, Dietrich CF. Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma. World J Gastroenterol 2016; 22:4741-4749. [PMID: 27217705 PMCID: PMC4870080 DOI: 10.3748/wjg.v22.i19.4741] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma (HEHE) in comparison to other multilocular benign focal liver lesions (FLL).
METHODS: Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in consensus.
RESULTS: HEHE manifested as a single (n = 3) or multinodular (n = 22) FLL. On CEUS, HEHE showed rim-like (18/25, 72%) or heterogeneous hyperenhancement (7/25, 28%) in the arterial phase and hypoenhancement (25/25, 100%) in the portal venous and late phases (PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas (18/25, 72%); in seven patients (7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature (P < 0.01).
CONCLUSION: CEUS allows for characterization of unequivocal FLL. By analyzing the hypoenhancement in the PVLP, CEUS can determine the malignant nature of HEHE.
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Hepatic epithelioid hemangioendothelioma. Clin Res Hepatol Gastroenterol 2016; 40:136-8. [PMID: 26546177 DOI: 10.1016/j.clinre.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/02/2015] [Indexed: 02/04/2023]
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Bally O, Tassy L, Richioud B, Decouvelaere AV, Blay JY, Derbel O. Eight years tumor control with pazopanib for a metastatic resistant epithelioid hemangioendothelioma. Clin Sarcoma Res 2015; 5:12. [PMID: 25969727 PMCID: PMC4428504 DOI: 10.1186/s13569-014-0018-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/04/2014] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Epithelioid hemangioendothelioma is a rare connective tissue tumor of vascular origin. It is most commonly found in young to middle aged women, and its clinical behavior is remakably variable from an indolent metastatic tumor to an aggressive rapidly growing neoplasm. Most tumors are diagnosed in an advanced unresectable phase and when clinically aggressive, require systemic cytotoxic treatment of sarcoma. Then, the 5-year survival rate after chemotherapy does not exceed 30%. Antiangiogenics are active in selected sarcoma subtypes: pazopanib, the only anti angiogenic registered agent for sarcoma provides a median PFS of 4.5 months only in the pivotal study. Their activity in EHE has been reported but long term outcome of these patients remain unreported. We report a case of a female patient with HEH who was treated with pazopanib for almost 8 years. Pazopanib therapy resulted in clinical improvement of symptoms and durable stabilization of liver tumors and lung lesions. CONCLUSION Pazopanib is a promising therapeutic option in patients with HEH.
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Affiliation(s)
- Olivia Bally
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
| | - Louis Tassy
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
| | - Bertrand Richioud
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
| | | | - Jean-Yves Blay
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
| | - Olfa Derbel
- Sarcoma Unit, Centre Léon Bérard, 28, Laennec street, 69008 Lyon, France
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Zhao XY, Rakhda MIA, Habib S, Bihi A, Muhammad A, Wang TL, Jia JD. Hepatic epithelioid hemangioendothelioma: A comparison of Western and Chinese methods with respect to diagnosis, treatment and outcome. Oncol Lett 2014; 7:977-983. [PMID: 24944653 PMCID: PMC3961446 DOI: 10.3892/ol.2014.1847] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 01/02/2014] [Indexed: 02/07/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare tumor of vascular origin. Whether HEHE in Chinese patients exhibits similar characteristics compared with Western patients is not well known. The aim of the present study was to summarize the characteristics of HEHE in Chinese patients and identify its prognostic factors. In total, six patients diagnosed with HEHE at the Beijing Friendship Hospital between 2000 and 2012 were combined with 44 previously reported cases in China, retrieved from the literature between 1989 and mid-2012. These 50 cases from China were compared with 402 patients from Western populations. Prognostic factors were identified by the χ2 test and Cox regression analysis. The male to female ratio of the Chinese patients was 1:2.1 with the mean age of 44.2 years (range, 22–86 years). The percentage of asymptomatic Chinese patients was significantly higher than in the Western patients (40.0 vs. 24.8%; P=0.026), and that of extrahepatic metastasis (16.0 vs. 36.6%; P=0.005) was significantly lower in Chinese patients. On imaging study, capsular retraction (59.5%) and calcification (26.0%), as well as positivity of CD34 (93.5%) and CD31 (80.6%), were more frequently found in the Chinese patients. Management for the Chinese patients included liver resection (LRx; 45.7%), liver transplantation (LTx; 5.7%), trans-catheter arterial chemoembolization (14.3%) and palliative treatment (34.3%). Chinese patients with larger-sized tumor nodules [relative risk (RR), 1.58; 95% confidence interval (CI), 1.032–2.422; P=0.035) and diffuse type (RR, 12.17; 95% CI, 1.595–92.979; P=0.016) exhibited unfavorable outcomes. In contrast to Western patients with HEHE, a larger number of Chinese patients were asymptomatic with less extrahepatic metastasis. In China, LRx is widely adopted rather than LTx. Chinese patients with large tumor size or diffuse type may encounter a poorer prognosis.
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Affiliation(s)
- Xin Yan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | | | - Sohail Habib
- International School of Capital Medical University, Beijing 100069, P.R. China
| | - Ali Bihi
- International School of Capital Medical University, Beijing 100069, P.R. China
| | - Abdullah Muhammad
- International School of Capital Medical University, Beijing 100069, P.R. China
| | - Tai Ling Wang
- Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Ji-Dong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
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Harada JI, Yoshida H, Ueda J, Mamada Y, Taniai N, Mineta S, Yoshioka M, Kawano Y, Shioda Y, Uchida E. Malignant hepatic epithelioid hemangioendothelioma with abdominal pain due to rapid progression. J NIPPON MED SCH 2011; 78:246-51. [PMID: 21869559 DOI: 10.1272/jnms.78.246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor. We report on a patient who underwent hepatectomy for malignant HEH associated with abdominal pain due to rapid progression. An 83-year-old man was admitted to Nippon Medical School Hospital because of acute, severe upper abdominal pain. Seven months before admission, a hepatic tumor, 3 cm in diameter, had been detected in the left lateral sector. The diagnosis was hepatic cavernous hemangioma. Abdominal ultrasonography revealed a heterogeneous hyperechoic tumor with a smooth border, 6 cm in diameter, in the left lateral sector (segment 3). Contrast-enhanced computed tomography of the abdomen showed that the tumor was enhanced from the early to the late phase. Abdominal angiography revealed a cotton wool-like appearance of the tumor. The diagnosis was hepatic cavernous hemangioma. A malignancy could not be ruled out because of the tumor's rapid growth, which had caused abdominal pain. Left hepatectomy was performed. Histopathological examination showed necrosis throughout the tumor. Slightly pleomorphic neoplastic cells with rounded, spindle-like nuclei and scant cytoplasm were sporadically found in vascular channels. Intracytoplasmic lumina occasionally contained red cells. Neoplastic cells were positive for factor VIII-related antigen, CD31, and CD34. The Mib-1 index was high. The tumor was diagnosed as malignant HEH. The postsurgical course was uneventful, and the patient was discharged on postoperative day 11. After 3 months, multiple metastatic tumors appeared in right hepatic lobe. Transcatheter arterial chemoembolization was performed.
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Affiliation(s)
- Jun-Ichiro Harada
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan.
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