1
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Finney N, Tran T, Hasjim BJ, Jakowatz J, Chiao E, Eng O, Wolf R, Jutric Z, Yamamoto M, Tran TB. Primary sarcoma of the liver: A nationwide analysis of a rare mesenchymal tumor. J Surg Oncol 2024; 129:358-364. [PMID: 37796036 DOI: 10.1002/jso.27477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/10/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary liver sarcomas are rare malignancies. Prognostic factors associated with long-term survival remain poorly understood. The objective of this study is to determine factors associated with long-term survival. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with visceral sarcoma arising from the liver. Demographic factors, tumor characteristics, resection status, and survival were evaluated. Multivariate Cox regression analysis was performed to determine predictors of survival. RESULTS A total of 743 patients with primary hepatic sarcoma were identified. The median tumor size was 10 cm. Only 30% (n = 221) of patients in the cohort underwent surgery. The 5-year overall survival rates were 47.9% for localized disease, 29.5% for regional disease, and 16.5% for distant disease, p < 0.001. Among patients who underwent surgical resection, patients with embryonal sarcoma had better 5-year survival compared with angiosarcoma and other histologic subtypes. On multivariate analysis, surgery was associated with improved survival, while older age, higher stage, and angiosarcoma histology were the strongest independent predictors of poor survival. CONCLUSIONS Surgery remains the mainstay of treatment for this rare malignancy but is performed in less than one-third of patients. Angiosarcoma histology is associated with worse overall survival, while surgical resection remains the strongest predictor of improved overall survival.
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Affiliation(s)
- Nicole Finney
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Tu Tran
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Bima J Hasjim
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - James Jakowatz
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Elaine Chiao
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Oliver Eng
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Ronald Wolf
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Zeljika Jutric
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Maki Yamamoto
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Thuy B Tran
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
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2
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Grimaldi C, de Ville de Goyet J, Bici K, Cianci MC, Callea F, Morabito A. The role of liver transplantation in the care of primary hepatic vascular tumours in children. Front Oncol 2022; 12:1026232. [PMID: 36505841 PMCID: PMC9730342 DOI: 10.3389/fonc.2022.1026232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Liver transplantation (LT) is the standard of care for many liver conditions, such as end-stage liver diseases, inherited metabolic disorders, and primary liver malignancies. In the latter group, indications of LT for hepatoblastoma and hepatocellular carcinoma evolved and are currently available for many non-resectable cases. However, selection criteria apply, as the absence of active metastases. Evidence of good long-term outcomes has validated the LT approach for managing these malignancies in the context of specialist and multidisciplinary approach. Nevertheless, LT's role in treating primary vascular tumours of the liver in children, both benign and malignant, remains somewhat controversial. The rarity of the different diseases and the heterogeneity of pathological definitions contribute to the controversy and make evaluating the benefit/risk ratio and outcomes quite difficult. In this narrative review, we give an overview of primary vascular tumours of the liver in children, the possible indications and the outcomes of LT.
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Affiliation(s)
- Chiara Grimaldi
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy,*Correspondence: Chiara Grimaldi,
| | - Jean de Ville de Goyet
- Department of Pediatrics, IRCCS-Istituto Mediterraneo per i Trapianti e Terapie ad altra specializzazione (ISMETT) (Institute for Scientific-Based Care and Research-Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Maria Chiara Cianci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Francesco Callea
- Department of Histopathology, Bugando Medical Centre, Catholic University of Healthy Allied Sciences, Mwanza, Tanzania
| | - Antonino Morabito
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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3
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Kniepeiss D, Talakić E, Portugaller RH, Fuchsjäger M, Schemmer P. Non-colorectal liver metastases: A review of interventional and surgical treatment modalities. Front Surg 2022; 9:945755. [PMID: 36406370 PMCID: PMC9666734 DOI: 10.3389/fsurg.2022.945755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/13/2022] [Indexed: 12/31/2023] Open
Abstract
Liver metastases (LM) occur in up to 90% either simultaneously with the diagnosis of the primary tumor or at a later time-point. While resection of colorectal LM and resection or transplantation of neuroendocrine LM is part of a standard therapy with a 5-year patient survival of up to 80%, resection of non-colorectal and non-neuroendocrine LM is still discussed controversially. The reason for it is the significantly lower survival benefit of all different tumor entities depending on the biological aggressiveness of the tumor. Randomized controlled trials are lacking. However, reviews of case series with ≥100 liver resections are available. They show a 5-year patient survival of up to 42% compared to only <5% in patients without treatment. Risk factors for poor survival include the type of primary tumor, a short interval between resection of the primary tumor and liver resection, extrahepatic manifestation of the tumor, number and size of the LM, and extent of liver resection. Overall, it has recently been shown that a good patient selection, the technical advances in surgical therapy and the use of a risk score to predict the prognosis lead to a significantly better outcome so that it is no longer justified not to offer liver resection to patients with non-colorectal, non- endocrine LM. Since modern therapy of LM is multimodal, the optimal therapeutic approach is decided individually by a multidisciplinary team consisting of visceral surgeons, oncologists, interventional radiologists and radiologists as part of a tumor board.
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Affiliation(s)
- Daniela Kniepeiss
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
| | - Emina Talakić
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of General Radiology, Medical University of Graz, Graz, Austria
| | - Rupert Horst Portugaller
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of General Radiology, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
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4
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Dobrindt EM, Öllinger R, Flörcken A, Märdian S, Schmelzle M, Lurje G, Pratschke J, Schoening W. Primäre Lebersarkome – Empfehlungen zur chirurgischen Therapie. Zentralbl Chir 2022; 148:165-179. [PMID: 35211924 DOI: 10.1055/a-1728-6939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eva Maria Dobrindt
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Robert Öllinger
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Anne Flörcken
- Medizinische Klinik m.S. Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sven Märdian
- Zentrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Moritz Schmelzle
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Georg Lurje
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Johann Pratschke
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wenzel Schoening
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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5
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Lang SA, Bednarsch J, Czigany Z, Joechle K, Kroh A, Amygdalos I, Strnad P, Bruns T, Heise D, Ulmer F, Neumann UP. Liver transplantation in malignant disease. World J Clin Oncol 2021; 12:623-645. [PMID: 34513597 PMCID: PMC8394155 DOI: 10.5306/wjco.v12.i8.623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/15/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation for malignant disease has gained increasing attention as part of transplant oncology. Following the implementation of the Milan criteria, hepatocellular carcinoma (HCC) was the first generally accepted indication for transplantation in patients with cancer. Subsequently, more liberal criteria for HCC have been developed, and research on this topic is still ongoing. The evident success of liver transplantation for HCC has led to the attempt to extend its indication to other malignancies. Regarding perihilar cholangiocarcinoma, more and more evidence supports the use of liver transplantation, especially after neoadjuvant therapy. In addition, some data also show a benefit for selected patients with very early stage intrahepatic cholangiocarcinoma. Hepatic epithelioid hemangioendothelioma is a very rare but nonetheless established indication for liver transplantation in primary liver cancer. In contrast, patients with hepatic angiosarcoma are currently not considered to be optimal candidates. In secondary liver tumors, neuroendocrine cancer liver metastases are an accepted but comparability rare indication for liver transplantation. Recently, some evidence has been published supporting the use of liver transplantation even for colorectal liver metastases. This review summarizes the current evidence for liver transplantation for primary and secondary liver cancer.
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Affiliation(s)
- Sven Arke Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Katharina Joechle
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Andreas Kroh
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Iakovos Amygdalos
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Pavel Strnad
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Tony Bruns
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Daniel Heise
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
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6
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Dhaliwal A, Braseth A, Dhindsa BS, Ramai D, Rochling FA. Liver Transplantation in a Patient With Hepatic Angiosarcoma. Cureus 2021; 13:e12609. [PMID: 33585099 PMCID: PMC7872500 DOI: 10.7759/cureus.12609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Liver transplantation (LT) is an accepted form of therapy for selected cases of malignant tumors of the liver that include primary and fibrolamellar hepatocellular carcinoma, cholangiocarcinoma limited to Klatskin distribution, neuroendocrine tumors, epithelioid hemangioendothelioma, and hepatoblastoma. This is the case of a 61-year-old previously healthy female transferred from an outside hospital for a second opinion for a liver transplant. Computed tomography of the abdomen with contrast showed cirrhosis and multiple masses with arterial enhancement in her liver. She underwent a liver biopsy that showed a low-grade vascular tumor. She underwent an exploratory laparotomy with open liver biopsy which showed no visual evidence of omental spread. The pathology was reported as a low-grade vascular lesion, which was likely a small vessel neoplasm. After denial for LT secondary to an unknown low-grade vascular tumor, she presented to our medical center. Oncology was consulted and diagnosed with her liver vascular tumors as benign with an overall favorable prognosis. She was listed for liver transplant with a model for end-stage liver disease-sodium score of 25 and developed hepatorenal syndrome type 1. She was on hemodialysis for approximately 10 weeks prior to her LT and was eventually listed for simultaneous liver and kidney transplants. She underwent an orthotopic liver transplant 10 weeks after presenting to UNMC. The amount of necrosis and the elevated mitotic rate was sufficient to classify the tumor as a Federation Nationale des Centres de Lutte le Cancer grade 3 of three angiosarcomas. She was scheduled for a living donor kidney transplant three days after her liver transplant, but it was postponed after she continued to have increased urine output that responded to a trial of diuretics with continued improvement in kidney function. She successfully completed 16 months post-LT without any known recurrence of primary angiosarcoma.
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Affiliation(s)
- Amaninder Dhaliwal
- Gastroenterology and Hepatology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Annie Braseth
- Gastroenterology and Hepatology, The University of Iowa Carver College of Medicine, Iowa City, USA
| | - Banreet S Dhindsa
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, USA
| | - Daryl Ramai
- Internal Medicine, The Brooklyn Hospital Center, New York, USA
| | - Fedja A Rochling
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, USA
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7
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Ecker BL, Maki RG, Cavnar MJ, DeMatteo RP. Surgical Management of Sarcoma Metastatic to Liver. Surg Oncol Clin N Am 2020; 30:57-67. [PMID: 33220809 DOI: 10.1016/j.soc.2020.08.002] [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] [Indexed: 12/19/2022]
Abstract
Sarcomas are rare mesenchymal tumors with a propensity for hematogenous metastasis. Gastrointestinal stromal tumor (GIST) is the most common histologic subtype and the most common source of hepatic metastases. In the case of metastatic GIST, neoadjuvant imatinib can be used as a selection tool for the judicious application of surgery, where treatment-responsive patients who undergo resection to prevent the development of treatment-resistant clones have associated 10-year actuarial survival of 40%. Further advances for many of the non-GIST sarcoma subtypes will depend on the development of improved systemic therapies and evaluation of their activity in subtype or molecularly defined trials.
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Affiliation(s)
- Brett L Ecker
- Department of Surgery, University of Pennsylvania, 3400 Spruce st, Philadelphia, PA 19104, USA.
| | - Robert G Maki
- Department of Medicine, University of Pennsylvania, 3400 Spruce st, Philadelphia, PA 19104, USA
| | - Michael J Cavnar
- Department of Surgery, University of Kentucky, 800 Rose St First Floor, Lexington, KY 40536, USA
| | - Ronald P DeMatteo
- Department of Surgery, University of Pennsylvania, 3400 Spruce st, Philadelphia, PA 19104, USA
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8
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Vella S, Cortis K, Pisani D, Pocock J, Aldrighetti L. Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy. BMJ Case Rep 2020; 13:13/2/e233567. [PMID: 32047090 DOI: 10.1136/bcr-2019-233567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We describe the case of a 77-year-old woman, presenting with non-specific epigastric pain. Physical examination and subsequent imaging revealed the presence of a large mass in the right liver lobe. This was shown to be a leiomyosarcoma on biopsy histology. Further investigation confirmed this to be a primary hepatic leiomyosarcoma with no evidence of metastases. The patient underwent successful surgical resection. She is currently under imaging follow-up, with no evidence of disease recurrence.
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Affiliation(s)
- Stephanie Vella
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | - Kelvin Cortis
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | - David Pisani
- Pathology Department, Mater Dei Hospital, Msida, Malta
| | - James Pocock
- Gastroenterology Department, Mater Dei Hospital, Msida, Malta
| | - Luca Aldrighetti
- Hepatobiliary Surgery Department, San Raffaele Hospital, Milano, Lombardia, Italy
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9
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Mont Alverne Pierre AM, Veras CM, Esmeraldo TM, Schwermann MP, Studart E Neves MS, Bastos Pinho JE, Canito Brasil IR. Liver Transplantation for Non-hepatocellular Carcinoma Malignancy: A Single-Center Experience. Transplant Proc 2019; 51:3355-3359. [PMID: 31669072 DOI: 10.1016/j.transproceed.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Liver transplantation has become an effective treatment for selected patients with hepatocellular carcinoma with excellent outcomes. More recent reports have described improved outcomes in liver transplantation in a subset of patients with other malignancies like hilar cholangiocarcinoma, unresectable hepatic epithelioid hemangioendothelioma and hepatic metastasis from neuroendocrine tumors. However, hepatic angiosarcoma remains an absolute contraindication to liver transplantation because of the poor outcome. OBJECTIVES The present study aims to describe liver transplantation for non-hepatocellular carcinoma malignancy. METHODS A retrospective analysis of patients and review of the literature was performed. RESULTS A total of 5 patients with non-hepatocellular carcinoma malignancy on explants histopathologic findings were identified. They presented hepatic epithelioid hemangioendothelioma (1), neuroendocrine tumor (1), angiosarcoma (1) and cholangiocarcinoma (2). The mean length of follow-up was 22.8 ± 37.67 (range, 2-90 months). Of 5 patients evaluated, 3 patients remain with stable graft function. CONCLUSION Future investigations are necessary to redefine the indications of liver transplantations to treat non-hepatocellular carcinoma malignancy and its limitation.
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Affiliation(s)
| | - Camila Monteiro Veras
- Liver Transplantation Division, Fortaleza General Hospital, Fortaleza, Ceara, Brazil
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10
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Liver transplantation for unresectable malignancies: Beyond hepatocellular carcinoma. Eur J Surg Oncol 2019; 45:2268-2278. [PMID: 31387755 DOI: 10.1016/j.ejso.2019.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/02/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022] Open
Abstract
Indications for liver transplantation have expanded over the past few decades owing to improved outcomes and better understanding of underlying pathologies. In particular, there has been a growing interest in the field of transplant oncology in recent years that has led to considerable developments which have pushed the boundaries of malignant indications for liver transplantation beyond hepatocellular carcinoma (HCC). In this article, we review and summarise the published evidence for liver transplantation in non-HCC primary and metastatic liver malignancies and highlight ongoing clinical trials that address unresolved questions therein. We also examine the current technical, immunological and oncological challenges that face liver transplantation in this growing field and explore potential approaches to overcome these barriers.
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11
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Diethylnitrosamine (DENA) recapitulates formation of hepatic angiosarcoma in pigs. PLoS One 2019; 14:e0214756. [PMID: 31095587 PMCID: PMC6522042 DOI: 10.1371/journal.pone.0214756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background & aim Primary hepatic angiosarcoma is a rare tumor with poor prognosis. The aim of this study was to generate a new angiosarcoma model to improve research on hepatic angiosarcoma. Methods Pigs sus scrofa were treated with different regimens of diethylnitrosamine (DENA). Tissues were analyzed by histology and immunohistochemistry. Serum parameters were determined. Angiosarcoma tissue was investigated for chromosomal aberrations by aCGH analysis. Results Animals of almost all different treatment regimens developed a multitude of variable liver lesions. Different tumor types such as granulation tissue type, cellular-like, hyalinization necrosis-like, angiosarcoma-like, dysplastic nodule-like, hepatocellular-like, glandular structure-like, and leiomyoma-like lesions were observed. Weekly treatment with 15 mg/kg for up to 52 weeks or a single shot of 200 mg/kg DENA led to the development of hepatic angiosarcomas. aCGH analysis of angiosarcoma tissue revealed increased alterations in tumors compared to non-tumorous tissue. Most of the chromosomal alterations were found on chromosomes 6, 7, 12, and 14. Conclusion In this preliminary study treatment of sus scrofa with weekly injections of 15 mg/kg DENA results in a new model for primary hepatic angiosarcoma. This model may help to shed light on the pathomechanisms of primary hepatic angiosarcoma and might therefore open new treatment options.
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12
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Lazăr DC, Avram MF, Romoșan I, Văcariu V, Goldiș A, Cornianu M. Malignant hepatic vascular tumors in adults: Characteristics, diagnostic difficulties and current management. World J Clin Oncol 2019; 10:110-135. [PMID: 30949442 PMCID: PMC6441663 DOI: 10.5306/wjco.v10.i3.110] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/23/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation (LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma (HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation Association-European Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma (HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient. Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches, alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.
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Affiliation(s)
- Daniela Cornelia Lazăr
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Mihaela Flavia Avram
- Department of Surgery X, 1st Surgery Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Ioan Romoșan
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Violetta Văcariu
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Adrian Goldiș
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Mărioara Cornianu
- Department of Pathology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
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13
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Tripke V, Heinrich S, Huber T, Mittler J, Hoppe-Lotichius M, Straub BK, Lang H. Surgical therapy of primary hepatic angiosarcoma. BMC Surg 2019; 19:5. [PMID: 30630447 PMCID: PMC6329081 DOI: 10.1186/s12893-018-0465-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary hepatic angiosarcoma (PHA) is a rare tumor entity. Radical surgical resection is currently considered the best treatment choice. The aim of this analysis is to report our experience with surgery for PHA. METHODS All resections of PHA from 01/2002 until 06/2017 were identified from our prospective institutional database. All cases were re-confirmed by a second pathologist. We analyzed completeness of resection, overall (OS) and disease-free survival (DFS). RESULTS Nine patients with PHA underwent hepatic resection. Median follow-up after surgery was 15.5 months (range: 3-144). At last follow-up 4/9 patients were alive, three of them without recurrence 15, 21 and 144 months after surgery. Five patients developed PHA recurrence. Four of these died 3 to 17 months after surgery. One patient with PHA recurrence is alive 15 months after surgery. Another patient without PHA recurrence died 59 months after surgery from pancreatic cancer. Median OS and DFS after resection was 18 months (range: 3-144 months) and 10 months (range: 2-144 months), respectively. After R-0 resection (n = 8), the median OS and DFS was 59 and 11 months. CONCLUSIONS Resection of PHA is the only approach to achieve complete tumor removal and offers a chance for long-term survival and should be evaluated in cases of PHA.
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Affiliation(s)
- Verena Tripke
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Stefan Heinrich
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Tobias Huber
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Jens Mittler
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Maria Hoppe-Lotichius
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Beate K Straub
- Institute of Pathology, University Hospital of Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
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14
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Gunasekaran V, Rammohan A, Reddy SM, Rela M. Liver transplantation for inferior vena cava leiomyosarcoma: from a Maslow's hammer to the Occam's razor. BMJ Case Rep 2018; 2018:bcr-2018-225827. [PMID: 30269090 DOI: 10.1136/bcr-2018-225827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Leiomyosarcoma (LMS) of primary vascular origin is a rare entity with only potentially curative option being complete surgical resection; despite which the prognosis remains dismal. Tumour recurrence is very common, and the benefits of adjuvant therapy are undefined. A 39-year-old woman presented with 6 months' history of abdominal pain, abdominal distension and pedal oedema. On evaluation, she was diagnosed to have chronic Budd-Chiari syndrome (BCS) secondary to a tumour arising from the inferior vena cava (IVC) on evaluation. Her liver decompensation included jaundice, gastrointestinal bleed and ascites. Following a detailed multidisciplinary team discussion, she underwent complete excision of the tumour along with a segment of the IVC with living donor liver transplantation. She remains disease-free 24 months following surgery. This is the first reported case of liver transplantation for IVC LMS causing chronic BCS.
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Affiliation(s)
- Vasanthakumar Gunasekaran
- Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India.,Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Ashwin Rammohan
- Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India.,Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Srinivas Mettu Reddy
- Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India.,Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India.,Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, Bharat Institute of Higher Education & Research, Chennai, Tamil Nadu, India.,Institute of Liver Studies, King's College Hospital, London, UK
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15
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Lerut J, Iesari S. Vascular tumours of the liver: a particular story. Transl Gastroenterol Hepatol 2018; 3:62. [PMID: 30363746 DOI: 10.21037/tgh.2018.09.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Vascular tumours of the liver represent an underrated chapter of medical and surgical hepatology. These tumours cover a wide spectrum ranging from the frequent and most benign hepatic haemangioma (HH), via the rare and intermediately aggressive hepatic epithelioid haemangioendothelioma (HEHE) to the rare and most malignant hepatic haemangiosarcoma (HHS). In contrast to the treatment algorithms for hepatocellular and cholangiocellular cancer, the diagnostic and therapeutic approaches to HEHE and HHS are not well developed. The related uncertainty is explained by their rare occurrence and their protean clinical, morphological (imaging) and histopathological presentation and behaviour. This article gives an update about these particular tumours based on the analysis of the recent literature and of the studies on vascular tumours published by the European Liver Intestine Transplantation Association (ELITA)-European Liver Transplant Registry (ELTR). It focuses also on the place of liver transplantation (LT) in the respective therapeutic algorithms. The differential diagnosis between these vascular and other tumour types may be very difficult. Correct diagnosis is of utmost importance and is based on a high index of clinical suspicion and on the integration of clinical, radiological, histological [including immunohistochemistry (IHC) and molecular biology findings]. Surgery, be it partial or total hepatectomy (LT), should be proposed whenever possible, because it is the therapeutic mainstay. In HEHE, LT provides excellent results, with long-term disease-free survivals (DFS) reaching 75%. Good results can be obtained even in case of (frequent) extrahepatic spread. Based on the extensive ELITA-ELTR study a HEHE-LT prognostic score has been proposed in order to estimate the risk of recurrence after LT. In contrast, results of surgery and LT are extremely poor for HHS, for the almost invariably rapid recurrence (within 6 months) and related death within 2 years. LT remains a contraindication for HHS. Due to the still important recurrence rate after surgical resection (25% in HEHE and almost 100% in HHS), there is an urgent need to develop pharmacological treatments targeting angiogenic and non-VEGF angiogenic pathways. To date, some prospective pilot studies and case reports have shown some short-term stabilisation of the disease in small groups of patients. In order to make progress, combination of surgery, anti-angiogenic and immunotherapy seems worthwhile. To complete the panel of vascular liver tumours, infantile haemangioendothelioma, haemangiopericytoma, nodular regenerative hyperplasia (NRH) and hepatic small vessel neoplasms (HSVN) are also discussed.
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Affiliation(s)
- Jan Lerut
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Samuele Iesari
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCL), Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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16
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Sanchez-Hidalgo JM, Duran-Martinez M, Molero-Payan R, Rufian-Peña S, Arjona-Sanchez A, Casado-Adam A, Cosano-Alvarez A, Briceño-Delgado J. Gastrointestinal stromal tumors: A multidisciplinary challenge. World J Gastroenterol 2018; 24:1925-1941. [PMID: 29760538 PMCID: PMC5949708 DOI: 10.3748/wjg.v24.i18.1925] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/27/2018] [Accepted: 05/06/2018] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs (> 95%) are positive for the KIT protein (CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis (the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvant Imatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.
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Affiliation(s)
- Juan Manuel Sanchez-Hidalgo
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Manuel Duran-Martinez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Rafael Molero-Payan
- Department of Intern Medicine, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
- Lipids and Atherosclerosis Research Unit, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Córdoba, Cordoba 14004, Spain
| | - Sebastian Rufian-Peña
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Alvaro Arjona-Sanchez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Angela Casado-Adam
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Antonio Cosano-Alvarez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Javier Briceño-Delgado
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
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17
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Joyon N, Dumortier J, Aline-Fardin A, Caramella C, Valette PJ, Blay JY, Scoazec JY, Dartigues P. Gastrointestinal stromal tumors (GIST) presenting in the liver: Diagnostic, prognostic and therapeutic issues. Clin Res Hepatol Gastroenterol 2018. [PMID: 28645742 DOI: 10.1016/j.clinre.2017.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Extra-gastrointestinal stromal tumors (E-GIST) presenting in the liver are exceedingly rare and raise difficult diagnostic and therapeutic challenges. METHODS We report on two cases of liver E-GIST with different clinical presentations. We describe their clinical and imaging features, their histopathological and molecular characteristics, their treatment and their course. RESULTS The first case was that of a 56-year-old male presenting with a 10-cm liver mass; the initial diagnosis, made in 1986 from a biopsy sample, was leiomyosarcoma; liver transplantation was performed in 1987; no extra-hepatic tumor was found; the course was uneventful until 1999, when tumor recurrence was diagnosed along the initial biopsy route; after reevaluation of available material, the definitive pathological diagnosis was GIST; imatinib treatment resulted in major response; the patient died of end-stage kidney disease 22 years after the initial diagnosis and 9 years after tumor recurrence. The second case is that of a 59-year-old female presenting with a 23-cm abdominal mass connected to the liver; on biopsy, the tumor was diagnosed as epithelioid GIST with exon 11 KIT mutation; imatinib treatment resulted in stable disease. CONCLUSIONS The diagnosis of E-GIST must be for any sarcoma presenting in the liver and confirmed by immunohistochemical and molecular techniques. Treatment might require aggressive strategies, which can be successful despite apparently adverse histoprognostic factors.
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Affiliation(s)
- Natacha Joyon
- Département de Biologie et Pathologie Médicales, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - Jérôme Dumortier
- Unité de Transplantation hépatique, Hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France
| | - Aude Aline-Fardin
- Service d'Anatomie Pathologique, CHU de Martinique-La-Meynard, 97261 Fort-de-France, France
| | - Caroline Caramella
- Département d'Imagerie Médicale, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - Pierre-Jean Valette
- Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France; Service de Radiologie Digestive, Hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Jean-Yves Blay
- Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France; Département d'Oncologie Médicale, Centre Léon-Bérard, 69008 Lyon, France
| | - Jean-Yves Scoazec
- Département de Biologie et Pathologie Médicales, Gustave-Roussy Cancer Campus, 94805 Villejuif, France; Faculté de Médecine de Bicêtre, Université Paris Saclay, Université Paris Sud, 94270 Le Kremlin-Bicêtre, France.
| | - Peggy Dartigues
- Département de Biologie et Pathologie Médicales, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
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18
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Tran Minh M, Mazzola A, Perdigao F, Charlotte F, Rousseau G, Conti F. Primary hepatic angiosarcoma and liver transplantation: Radiological, surgical, histological findings and clinical outcome. Clin Res Hepatol Gastroenterol 2018; 42:17-23. [PMID: 28416360 DOI: 10.1016/j.clinre.2017.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/09/2017] [Indexed: 02/04/2023]
Abstract
Angiosarcoma is a rare type of soft tissue sarcoma that accounts for less than 1% of all sarcomas and only 2% of all primary hepatic tumours. Thorotrast, arsenic, and vinyl chloride monomer are frequently listed as occupational exposure risks. The estimated latency is long (10-40 years) in occupational cases and very long (60 years or more) in non-occupational cases. The symptoms and CT-scan appearance of hepatic angiosarcoma (HAS) are non-specific. We present a case of a 65-year-old Caucasian male with history of cryptogenic cirrhosis, low alpha-foetoprotein levels and a single, 4-cm nodule of potential atypical hepatocellular carcinoma (no washout at MRI and CT-scan) in segment VIII. Laparoscopic radiofrequency ablation (a biopsy of the neoplastic lesion was technically impossible) was performed, followed by liver transplantation (LT) 6 months later. High-grade multifocal HAS was found in the explanted liver, with extensive involvement of the venous portal structures. No complications were observed during the postoperative course, and initial immunosuppression included tacrolimus, mycophenolate mofetil and corticosteroids. Because of the histological findings, tacrolimus was switched to everolimus as the main immunosuppressive drug one month after LT. Despite this conversion, the patient developed bone metastases 3 months after LT and peritoneal carcinosis one month later. This case report suggests that everolimus conversion does not inhibit the development of tumour metastases. Consequently, HAS remains an absolute contraindication to LT because of the poor outcome. If LT has been performed for incidental HAS, new molecular therapies (e.g. vascular endothelial growth factor antagonists) should be considered immediately after LT to improve the outcome.
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Affiliation(s)
- M Tran Minh
- Unité Médicale de Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France; Medicina Traslazionale, Università Piemonte Orientale Amedeo Avogrado, Novara, Italy
| | - A Mazzola
- Unité Médicale de Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - F Perdigao
- Service de Chirurgie Hépatobiliaire et Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - F Charlotte
- Service d'Anatomie et Cytologie Pathologique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - G Rousseau
- Service de Chirurgie Hépatobiliaire et Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - F Conti
- Unité Médicale de Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France; UMR_S 938, CDR Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, 75005 Paris, France.
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19
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Wadhwa S, Kim TH, Lin L, Kanel G, Saito T. Hepatic angiosarcoma with clinical and histological features of Kasabach-Merritt syndrome. World J Gastroenterol 2017; 23:2443-2447. [PMID: 28428724 PMCID: PMC5385411 DOI: 10.3748/wjg.v23.i13.2443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/23/2016] [Accepted: 01/04/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatic angiosarcoma is a mesenchymal tumor originating from liver sinusoidal endothelial cells. It is an extremely rare malignant neoplasm accounting for less than 1% of primary malignant liver tumors. The deregulated coagulopathy that can be seen in hepatic angiosarcoma fulfills the clinical diagnostic criteria of disseminated intravascular coagulation. However, the mechanism that governs this coagulopathy has been poorly understood. This case report provides histological evidence of the consumption of coagulation factors along with trapped platelets occurring within the tumor, which is the foundation for the concept of Kasabach-Merritt syndrome (KMS). KMS is characterized by thrombocytopenia and hyperconsumption of coagulation factors within a vascular tumor. However, KMS associated with angiosarcoma has not been well recognized. This case report describes, for the first time, the histological evidence of KMS that occurred in an extremely rare mesenchymal malignant tumor of the liver.
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20
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Experiences with surgically treated primary or secondary hepatic sarcoma. Langenbecks Arch Surg 2017; 402:585-590. [PMID: 28110373 DOI: 10.1007/s00423-017-1558-9] [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: 11/14/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Liver resection in hepatic sarcoma is rare, but other alternative treatment options are scarce. Surgery offers the only aggressive approach to achieve a tumour-free state. The aim of this investigation was to evaluate the outcome and survival of these patients at a single hepato-biliary university hospital. METHODS Between January 2004 and July 2013, 896 anatomical liver resections were performed. Eleven liver resections (1.2%) were performed due to primary hepatic sarcoma or hepatic sarcoma metastases. The demographic and clinical parameters were collected from the institutional patients' records. RESULTS In eight patients (83%), liver resection was performed due to hepatic sarcoma metastases. The surgical procedures were as follows: two patients (18%) had segmentectomy, six patients (55%) had hemihepatectomy or extended hemihepatectomy and three patients (27%) had multivisceral resections. In nine patients (82%), the resection margins were tumour free. In 55% (n = 6) of the patients, the maximal tumour diameter was greater than 10 cm. The postoperative morbidity was low with a Clavien-Dindo score of 2 (range 0-5). One patient died on postoperative day 2 after multivisceral resection. During the follow-up of 932 days (range 2-2.220 days) the 1-, 2- and 3-year survival rates were 91, 63 and 45%, respectively. Tumour recurrence was detected in seven patients (63%). CONCLUSIONS Liver resections in patients with primary or secondary hepatic sarcoma are rare. The main goal in these patients is to achieve complete tumour resection because chemotherapy offers no suitable alternative, but the long-term survival rates are limited because of high a recurrence rate even after aggressive surgical approaches.
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21
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Millan M, Delgado A, Caicedo LA, Arrunategui AM, Meneses CA, Villegas JI, Serrano O, Caicedo L, Duque M, Echeverri GJ. Liver Angiosarcoma: Rare tumour associated with a poor prognosis, literature review and case report. Int J Surg Case Rep 2016; 28:165-168. [PMID: 27718433 PMCID: PMC5061303 DOI: 10.1016/j.ijscr.2016.09.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022] Open
Abstract
Liver Angiosarcoma is rare and aggressive tumour that requires surgical management. Partial Hepatectomy is the ideal surgical management for Liver Angiosarcoma. Liver transplant does not improve the survival of Liver Angiosarcoma patients.
Introduction Liver angiosarcoma is a very uncommon tumour of mesenchymal origin, representing between 0.1–2% of all primary tumours of the liver, affecting mainly men in their sixth or seventh decade of life, with a high mortality in the first years (Chaudhary et al., 2015). Literature reports of its surgical treatment vary from a total or partial hepatectomy with or without liver transplant. Presentation of case A 37 year old male, with a 7 year history of a fatty liver, was found to have a 12 cm diameter tumour in a cirrhotic liver, during an abdominal Computed Tomography (CT) scan. Patient was asymptomatic with negative tumour markers, yet tumour liver biopsy revealed a Liver Angiosarcoma with positive immunohistochemistry for neoplastic cells CD31 and CD34. Patient was deemed candidate for a partial hepatectomy of the affected liver segments which was done without complications and no evidence of other tumour lesions was found during surgery. Patient continued oncologic management with ongoing chemotherapy. Discusion Liver Angiosarcoma, although rare, persists with a high mortality due to its aggressive nature. Never the less liver transplantation, although proven to be an effective treatment for many pathologies that culminate in liver failure, fails to improve patients’ survival and prognosis, when compared to partial hepatectomy as surgical management to for liver Angiosarcoma, Conclusion Partial hepatectomy as surgical management, followed by adjuvant therapy, for Liver Angiosarcoma continues to prove favourable results and prognosis compared to Liver Transplantation.
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Affiliation(s)
- Mauricio Millan
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Alejandro Delgado
- Centro de Investigaciones Clínicas, Fundación Valle del Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Luis A Caicedo
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | | | | | - Jorge I Villegas
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Oscar Serrano
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Liliana Caicedo
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Mauricio Duque
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia
| | - Gabriel J Echeverri
- Transplant Surgery Department, Fundación Valle de Lilí, Cali, Colombia; Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia.
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Liver transplantation for hepatobiliary malignancies: a new era of "Transplant Oncology" has begun. Surg Today 2016; 47:403-415. [PMID: 27130463 DOI: 10.1007/s00595-016-1337-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/06/2016] [Indexed: 01/10/2023]
Abstract
The indications of liver transplantation for hepatobiliary malignancies have been carefully expanded in a stepwise fashion, despite the fundamental limitations in oncological, immunological, and technical aspects. A new era of "Transplant Oncology," the fusion of transplant surgery and surgical oncology, has begun, and we stand at the dawn of a paradigm shift in multidisciplinary cancer treatment. For hepatocellular carcinoma, new strategies have been undertaken to select recipients based on biological and dynamic markers instead of conventional morphological and static parameters, opening the doors for a more deliberate expansion of the Milan criteria and locoregional therapies before liver transplantation. Neoadjuvant chemoradiation therapy followed by liver transplantation for unresectable perihilar cholangiocarcinoma developed by the Mayo Clinic provided excellent outcomes in a US multicenter study; however, the surgical indications are not necessarily universal and await international validation. Similarly, an aggressive multidisciplinary approach has been applied for other tumors, including intrahepatic cholangiocarcinoma, hepatoblastoma, liver metastases from colorectal and neuroendocrine primary and gastrointestinal stromal tumors as well as rare tumors, such as hepatic undifferentiated embryonal sarcoma and infantile choriocarcinoma. In conclusion, liver transplantation is an important option for hepatobiliary malignancies; however, prospective studies are urgently needed to ensure the appropriate patient selection, organ allocation and living donation policies, and administration of antineoplastic immunosuppression.
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23
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Kallam A, Krishnamurthy J, Kozel J, Shonka N. Undifferentiated Embryonal Sarcoma of Liver. Rare Tumors 2015; 7:6009. [PMID: 26788276 PMCID: PMC4703922 DOI: 10.4081/rt.2015.6009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/22/2015] [Indexed: 01/12/2023] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant hepatic tumor. A 47 year old male presented with symptoms of sour taste in his mouth, occasional nausea, indigestion and 15-pound weight loss over two months. He had an unremarkable upper gastrointestinal endoscopy. Imaging showed a large liver mass in the left hepatic lobe that was resected and then reported as UESL. He went on to develop lung metastases and was initially treated with doxorubicin and ifosfamide followed by switching of therapy to gemcitabine and docetaxel due to progression of disease. He had a good response after two cycles and went on to receive four more cycles, achieving stable disease. We can therefore conclude that the combination of gemcitabine and docetaxel is a potential therapeutic option for patients with UESL.
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Affiliation(s)
- Avyakta Kallam
- Department of Oncology/Hematology, Creighton University School of Medicine , Omaha, NE
| | - Jairam Krishnamurthy
- Division of Oncology/Hematology, Department of Medicine, University of Nebraska Medical Center , Omaha, NE, USA
| | - Jessica Kozel
- Division of Oncology/Hematology, Department of Medicine, University of Nebraska Medical Center , Omaha, NE, USA
| | - Nicole Shonka
- Division of Oncology/Hematology, Department of Medicine, University of Nebraska Medical Center , Omaha, NE, USA
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Abstract
Liver transplantation (LT) has become an acceptable and effective treatment for selected patients with hepatocellular carcinoma with excellent outcomes. More recently, LT has been tried in different primary and secondary malignancies of the liver. The outcomes of LT for very selected group of patients with hilar cholangiocarcinoma (CCA) have been promising. Excellent results have been reported in LT for patients with unresectable hepatic epithelioid hemangioendothelioma (HEHE). In contrast to excellent results after LT for HEHE, results of LT for angiosarcoma have been disappointing with no long-term survivors. Hepatoblastoma (HB) is the most common primary liver cancer in pediatric age group. Long-term outcomes after LT in patients with unresectable tumor and good response to chemotherapy have been promising. Indication for LT for hepatic metastasis from neuroendocrine tumors (NETs) is mainly for patients with unresectable tumors and for palliation of medically uncontrollable symptoms. Posttransplant survival in those patients with low tumor activity index is excellent, despite recurrence of the tumor. More recent limited outcomes data on LT for unresectable hepatic metastases from colorectal cancer have claimed some survival benefit compared to the previous reports. However, due to the high rate of tumor recurrence in a very short time after LT, especially in the era of organ shortage, this indication has not been favored by the transplant community.
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25
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Lin YH, Lin CC, Concejero AM, Yong CC, Kuo FY, Wang CC. Surgical experience of adult primary hepatic sarcomas. World J Surg Oncol 2015; 13:87. [PMID: 25880743 PMCID: PMC4358880 DOI: 10.1186/s12957-015-0489-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 01/26/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Primary hepatic sarcoma (PHS) is a rare primary liver malignancy. The histological types of PHS are diverse, and the clinical outcomes and management mainly depend on the histopathology. This study aims to evaluate the results of surgical intervention. METHODS Between January 2003 and June 2009, 13 adult patients with pathologically proven PHS were identified by record review. The patients' demographic profile, tumor characteristics, treatment modalities, and outcomes were reviewed and analyzed. The end of follow-up was December 2014. RESULTS Nine (69%) underwent curative liver resection and two underwent liver transplantation; the others received non-operative treatments. The pathologic findings were six (46%) angiosarcomas, four (30.7%) undifferentiated sarcomas, one (7.6%) leiomyosarcoma, one (7.6%) malignant mesenchymoma, and one (7.6%) hepatic epithelioid hemangioendothelioma. The median follow-up was 31.4 (2.8 ~ 142.5) months. The 1-, 2-, and 5-year survival of surgical patients were 72.7%, 63.6%, and 36.4%, respectively. Importantly, the 1-, 2-, and 5-year survival rates of non-angiosarcoma patients were superior to those of angiosarcoma (85.7% vs. 33.3%, 71.4% vs. 16.7%, and 57.1% vs. 0%, respectively, P = 0.023). CONCLUSIONS Surgical intervention provides the possibility of long-term survival from PHS. Angiosarcoma is associated with a more dismal outcome than non-angiosarcoma.
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Affiliation(s)
- Yu-Hung Lin
- Department of Surgery of Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Da-Pei Road, Niao-Sung, Kaohsiung, 83301, Taiwan.
| | - Chih-Che Lin
- Department of Surgery of Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Da-Pei Road, Niao-Sung, Kaohsiung, 83301, Taiwan.
| | - Allan M Concejero
- Department of Surgery of Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Da-Pei Road, Niao-Sung, Kaohsiung, 83301, Taiwan.
| | - Chee-Chien Yong
- Department of Surgery of Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Da-Pei Road, Niao-Sung, Kaohsiung, 83301, Taiwan.
| | - Fang-Ying Kuo
- Department of Pathology of Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan.
| | - Chih-Chi Wang
- Department of Surgery of Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Da-Pei Road, Niao-Sung, Kaohsiung, 83301, Taiwan.
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Abstract
BACKGROUND Some intra-abdominal or retroperitoneal tumors such as low-grade slow-growing malignancies may seem unresectable due to major vessel encasement or presence of intra-abdominal dissemination, but the slow growth rate and to some extent long life expectancy of the patients urge us to find some strategies to cure the patients or at least achieve tumor remission or symptom palliation. En bloc resection, followed by multivisceral or liver-sparing "modified" multivisceral transplantation has recently been used for treatment of these patients. RESULTS Between May 2010 and October 2012, 3 multivisceral and 3 modified multivisceral transplantations were performed in 6 patients (aged 14 to 55 years; mean, 32 years) with some slow growing intra-abdominal malignancies (2 neuroendocrine tumors, 2 gastrointestinal stromal tumors, 1 desmoid tumor, and 1 low-grade sarcoma). All patients survived the procedure. One patient died of pancytopenia 2 months after transplantation and another died with pulmonary emboli at 4 months. The remaining 4 patients are alive without any evidence of disease recurrence. CONCLUSIONS Although large intra-abdominal desmoid tumors, well-differentiated neuroendocrine tumors, and gastrointestinal stromal tumors are slow growing, they tend to invade locally, especially to the mesenteric root and/or celiac axis and other abdominal viscera. Complete resection followed by multivisceral transplantation could be a therapeutic option for these advanced tumors.
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Xue M, Masand P, Thompson P, Finegold M, Leung DH. Angiosarcoma successfully treated with liver transplantation and sirolimus. Pediatr Transplant 2014; 18:E114-9. [PMID: 24641525 DOI: 10.1111/petr.12245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2014] [Indexed: 12/14/2022]
Abstract
Malignant liver tumors represent approximately 1% of malignancies in children. HA is a high-grade tumor of endothelial cells that is even more rare in the pediatric population. HA has a limited response to chemotherapy, radiation and resection with universal tumor recurrence with LT and nearly 100% mortality by 18 months. This is the first reported successful case of hepatic angiosarcoma in a child who was treated by LT in combination with sirolimus. Sirolimus antagonizes the mTOR pathway, which regulates cell proliferation, differentiation, and migration, and is being studied as an anti-neoplastic agent for solid tumors.
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Affiliation(s)
- Megan Xue
- Pediatrics Baylor College of Medicine, Houston, TX, USA
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28
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Hibi T, Shinoda M, Itano O, Kitagawa Y. Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine. Organogenesis 2014; 10:241-9. [PMID: 24836922 DOI: 10.4161/org.29245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Significant achievements in the organ replacement approach for malignancies over the last 2 decades opened new horizons, and the age of "Transplant Oncology" has dawned. The indications of liver transplantation for malignancies have been carefully expanded by a strict patient selection to assure comparable outcomes with non-malignant diseases. Currently, the Milan criteria, gold standard for hepatocellular carcinoma, are being challenged by high-volume centers worldwide. Neoadjuvant chemoradiation therapy and liver transplantation for unresectable hilar cholangiocarcinoma has been successful in specialized institutions. For other primary and metastatic liver tumors, clinical evidence to establish standardized criteria is lacking. Intestinal and multivisceral transplantation is an option for low-grade neoplasms deemed unresectable by conventional surgery. However, the procedure itself is in the adolescent stage. Solid organ transplantation for malignancies inevitably suffers from "triple distress," i.e., oncological, immunological, and technical. Organ bioengineering and regenerative medicine should serve as the "triple threat" therapy and revolutionize "Transplant Oncology."
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Affiliation(s)
- Taizo Hibi
- Department of Surgery; Keio University School of Medicine; Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery; Keio University School of Medicine; Tokyo, Japan
| | - Osamu Itano
- Department of Surgery; Keio University School of Medicine; Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery; Keio University School of Medicine; Tokyo, Japan
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Treatment of undifferentiated embryonal sarcoma of the liver in children--single center experience. J Pediatr Surg 2013; 48:2202-6. [PMID: 24210186 DOI: 10.1016/j.jpedsurg.2013.05.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/14/2013] [Accepted: 05/14/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Undifferentiated embryonal sarcoma of the liver (UESL) represents less than 5% of all malignant hepatic tumors in childhood. It is considered an aggressive neoplasm with an unfavorable prognosis. The aim of this paper is to present a single center experience in the treatment of children with UESL. MATERIALS AND METHODS Ten children with UESL were treated between 1981 and 2012. Age at diagnosis ranged from 4 months to 17 years (median age, 6 years and 9 months). Surgery after neoadjuvant chemotherapy (CHT) was performed in 7 patients, and in 3 patients primary surgery was done. Adjuvant chemotherapy was administered in all 10 patients (CYVADIC, CAV, CAV/ETIF/IF+ADM, CDDP/PLADO). Right hemihepatectomy was performed in 1 patient, extended right hemihepatectomy in 6, and partial resection of the right lobe (segments V-VI, segment V) in 2 patients. One patient with unresectable tumor affecting both lobes was listed for liver transplantation (LTx). RESULTS Follow-up from diagnosis ranged from 50 to 222 months (mean 138 months). Among 9 patients treated with partial liver resection, distant metastases/local recurrence was not observed in any, and disease-free survival in this group is 100% (9 patients alive). The patient that underwent liver transplantation died of multiorgan failure 4 months postoperatively. However, this patient was misdiagnosed as having hepatoblastoma (HBL) and received PLADO chemotherapy. The overall survival rate is 90%. CONCLUSION Excellent results with long-term survival can be achieved in children with UESL with conventional therapy, including a combination of neoadjuvant and adjuvant chemotherapy and surgery, even in large extensively growing tumors.
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A rare occurrence of primary hepatic leiomyosarcoma associated with epstein barr virus infection in an AIDS patient. Case Rep Gastrointest Med 2013; 2013:691862. [PMID: 24024048 PMCID: PMC3760271 DOI: 10.1155/2013/691862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 07/23/2013] [Indexed: 12/25/2022] Open
Abstract
Primary hepatic leiomyosarcoma is exceedingly rare accounting for less than 1% of the hepatic tumors. Close to 45 cases have been reported in the English literature. Presentation is usually nonspecific and diagnosis is often delayed until tumors reach a large size. This leads to a dismal prognosis. The tumors are not yet fully understood, hence the standard of care is not well defined. Curative resection remains the mainstay of management. Close association of Epstein Barr virus (EBV) induced soft tissue sarcomas is proven, especially in the presence of immunosuppression encountered in HIV/AIDS patients and in posttransplant patients. We herein present a case report of a 54-year-old man diagnosed to have HIV/AIDS and EBV infection admitted to our hospital with complaints of intractable hiccups for more than a week. Extensive workup revealed primary leiomyosarcoma of the liver.
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Hepatic hemangiosarcoma: an absolute contraindication to liver transplantation--the European Liver Transplant Registry experience. Transplantation 2013; 95:872-7. [PMID: 23354302 DOI: 10.1097/tp.0b013e318281b902] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver transplantation (LT) is performed for hemangiosarcoma (HAS) despite disappointing results. METHODS Retrospective study of 14 males and 8 females reported to the European Liver Transplant Registry. In view of the difficult differential diagnosis between HAS and hemangioendothelioma (HE), the study was deliberately restricted to the period 1986 to 2004 to allow comparison of clinical and biochemical behavior of HAS and HE liver recipients transplanted during the same time period. RESULTS Clinical signs, symptoms, and biochemical parameters differed significantly. Pre-LT diagnosis of HAS was made in only 5 of 16 (31%) biopsied patients. HE (7 patients) and hepatocellular cancer (2 patients) were confounding diagnoses leading to LT. Extrahepatic disease was present at time of LT in 4 (19%) patients. Giant invalidating tumor (5 HAS, 1 with Budd-Chiari syndrome [BCS], and 10 supposed epithelioid hemangioendothelioma, 1 with BCS), acute BCS of unknown origin (2 patients), chronic liver failure (4 patients), and solitary hepatocellular cancer (1 patient) were the main indications for LT. Overall survival was 7.2±2.6 months; no patient survived after 23 months. Recurrence was diagnosed after 5.0±2.6 months. Seventeen (77.2%) patients died of tumor recurrence, and the remaining 5 patients died of early infections. CONCLUSIONS HAS is an absolute contraindication to LT due to the poor outcome. When dealing with the difficult differential diagnosis between HAS and HE, futile LT can be avoided by taking into consideration their distinct clinical and biochemical behaviors as well as a 6-month wait-list observation period. This time period enables the evaluation of HAS disease progression without compromising prognosis of HE patients, thereby allowing to avoid organ wastage.
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32
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Chemosaturation with Percutaneous Hepatic Perfusion for Unresectable Isolated Hepatic Metastases from Sarcoma. Cardiovasc Intervent Radiol 2012; 35:1480-7. [DOI: 10.1007/s00270-012-0425-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/21/2012] [Indexed: 12/13/2022]
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Shivathirthan N, Kita J, Iso Y, Hachiya H, Kyunghwa P, Sawada T, Kubota K. Primary hepatic leiomyosarcoma: Case report and literature review. World J Gastrointest Oncol 2011; 3:148-52. [PMID: 22046492 PMCID: PMC3205114 DOI: 10.4251/wjgo.v3.i10.148] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/21/2011] [Accepted: 09/28/2011] [Indexed: 02/05/2023] Open
Abstract
Primary hepatic leiomyosarcoma are rare tumors with less than 30 cases reported in the English literature. Non specific presentations and often diagnosis delayed until they reach a large size, is the norm with therapy leading to an often dismal prognosis. A 67-year-old man presented complaining of abdominal pain and a palpable abdominal mass since Jan 2010. Abdominal ultrasonography and abdominal computed tomography revealed a large tumor in the left lobe of the liver. Surgical exploration was undertaken and an extended left hepatectomy with extension onto the dorsal part of segment 8 preserving the MHV with partial resection of segment 6 was undertaken. The weight of the resected specimen was 1300 g of the left lobectomy specimen and 8 g of the segment 6 partial resection specimen. The pathology report confirmed the diagnosis of leiomyosarcoma. On immunohistochemistry, the tumor cells were positive for smooth muscle actin stain. The patient is on regular follow up and is currently 9 mo post resection with no evidence of recurrence. We report the case of a resected primary hepatic leiomyosarcoma and emphasize the need for a global database for these rare tumors to promote a better and broader understanding of this less understood subject.
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Affiliation(s)
- Nairuthya Shivathirthan
- Nairuthya Shivathirthan, Junji Kita, Yukihiro Iso, Hiroyuki Hachiya, Park KyungHwa, Tokihiko Sawada, Keiichi Kubota, Second Department of Surgery, Dokkyo Medical University, 880 Kita Kobayashi, Mibu, Tochigi 321-0293, Japan
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34
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Frilling A, Malago M, Testa G, Schleyer E, Grabellus F, Kronenberger R, Li J, Broelsch CE. Liver transplantation for metastasized extragastrointestinal stromal tumor: a case report and an overview of literature. Transplant Proc 2011; 42:3843-8. [PMID: 21094867 DOI: 10.1016/j.transproceed.2010.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 06/18/2010] [Indexed: 11/29/2022]
Abstract
A 63-year-old woman underwent living donor liver transplantation for hepatic metastases of an extragastrointestinal stromal tumor (EGIST) originating from the rectovaginal space. Due to a multifocal extrahepatic tumor recurrence, treatment with imatinib mesylate was started after extensive pharmacokinetic studies to rule out possible interactions with immunosuppressives. We performed several re- resections for EGIST recurrence thereafter. At the last follow-up, 17 years after primary tumor resection and 10 years after living donor liver transplantation, the patient is symptom-free under immunosuppressive and imatinib mesylate treatments with a 2-cm stable recurrent pararectal EGIST. To our knowledge, this is the only report published on a patient who underwent transplantation for hepatic EGIST metastases with a posttransplantation follow-up of 10 years and the first report on living donor liver transplantation for metastasized EGIST. This is the first description of pharmacokinetics of imatinib and its main active metabolite CGP74588 in a liver transplant recipient.
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Affiliation(s)
- A Frilling
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
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35
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Grossman EJ, Millis JM. Liver transplantation for non-hepatocellular carcinoma malignancy: Indications, limitations, and analysis of the current literature. Liver Transpl 2010; 16:930-42. [PMID: 20677284 DOI: 10.1002/lt.22106] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Orthotopic liver transplantation (OLT) is currently incorporated into the treatment regimens for specific nonhepatocellular malignancies. For patients suffering from early-stage, unresectable hilar cholangiocarcinoma (CCA), OLT preceded by neoadjuvant radiotherapy has the potential to readily achieve a tumor-free margin, accomplish a radical resection, and treat underlying primary sclerosing cholangitis when present. In highly selected stage I and II patients with CCA, the 5-year survival rate is 80%. As additional data are accrued, OLT with neoadjuvant chemoradiation may become a viable alternative to resection for patients with localized, node-negative hilar CCA. Hepatic involvement from neuroendocrine tumors can be treated with OLT when metastases are unresectable or for palliation of medically uncontrollable symptoms. Five-year survival rates as high as 90% have been reported, and the Ki67 labeling index can be used to predict outcomes after OLT. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin. The data from single-institution series are limited, but compiled reviews have reported 1- and 10-year survival rates of 96% and 72%, respectively. Hepatoblastoma is the most common primary hepatic malignancy in children. There exist subtle differences in the timing of chemotherapy between US and European centers; however, the long-term survival rate after transplantation ranges from 66% to 77%. Fibrolamellar hepatocellular carcinoma is a distinct liver malignancy best treated by surgical resection. However, there is an increasing amount of data supporting OLT when resection is contraindicated. In the treatment of either primary or metastatic hepatic sarcomas, unacceptable survival and recurrence rates currently prohibit the use of OLT.
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Affiliation(s)
- Eric J Grossman
- Section of Transplantation, Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
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36
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Faraj W, Mukherji D, El Majzoub N, Shamseddine A, Shamseddine A, Khalife M. Primary undifferentiated embryonal sarcoma of the liver mistaken for hydatid disease. World J Surg Oncol 2010; 8:58. [PMID: 20615265 PMCID: PMC2913916 DOI: 10.1186/1477-7819-8-58] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 07/09/2010] [Indexed: 12/18/2022] Open
Abstract
Primary undifferentiated embryonal sarcoma of the liver is a rare tumor with a peak incidence between the ages of 6 and 10 years. We report a case of a primary hepatic undifferentiated embryonal sarcoma arising in a 21-year-old male mistaken for hydatid disease of the liver. The rapid recurrence of this tumor along the site of attempted percutaneous drainage illustrates some important management points regarding this malignancy.
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Affiliation(s)
- Walid Faraj
- Department of Surgery, HPB and liver transplantation unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Internal medicine, Oncology unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadim El Majzoub
- Department of Internal medicine, Oncology unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal medicine, Oncology unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Achraf Shamseddine
- Department of Surgery, HPB and liver transplantation unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamed Khalife
- Department of Surgery, HPB and liver transplantation unit, American University of Beirut Medical Center, Beirut, Lebanon
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37
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Shamseddine A, Faraj W, Mukherji D, El Majzoub N, Khalife M, Soubra A, Shamseddine A. Unusually young age distribution of primary hepatic leiomyosarcoma: case series and review of the adult literature. World J Surg Oncol 2010; 8:56. [PMID: 20594305 PMCID: PMC2902476 DOI: 10.1186/1477-7819-8-56] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 07/01/2010] [Indexed: 12/12/2022] Open
Abstract
Background Primary hepatic leiomyosarcoma is a rare disease diagnosed in older aged adults with a median age of 58 and occasionally in children with a history of immunosuppression. Methods From 1998 to 2009, 215 patients were diagnosed with primary hepatic malignancies at our institution, 4 of which were diagnosed with primary hepatic sarcoma (1.8%). Three cases were primary hepatic leiomyosarcomas (LMS) and one case was primary undifferentiated embryonal sarcoma of the liver; median age 30 (range 20-39) years. Results One patient is currently 12 months post-resection with no evidence of recurrence. Two patients passed away at 19 days and 22 months from small for size liver and tumor recurrence respectively. Conclusion We have presented 3 cases of primary hepatic leiomyosarcoma diagnosed at our institution with an unusually young age distribution and no evidence of immunosuppression. These cases highlight the diagnostic and therapeutic challenges of this rare tumour.
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Affiliation(s)
- Achraf Shamseddine
- Department of Surgery, HPB and Liver Transplantation Unit, American University of Beirut Medical Center, Beirut, Lebanon
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38
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Abstract
Based on analysis of the literature and of the audited ELITA (European Liver Intestinal Transplant Association)-ELTR (European Liver Transplant Registry) data, the place of liver transplantation (LT) in the treatment of vascular tumours is discussed. Hepatic epithelioid haemangioendothelioma has currently become a good indication for LT with 5- and 10-year post-LT patient survival rates of 83% and 74% respectively and 5- and 10-year recurrence-free survival rates of 82% and 64% respectively. In contrast, the results of LT for haemangiosarcoma (HAS) are disastrous with an universal tumour recurrence within 6 months and no single patient survival after 2 years. Therefore, HAS remains an absolute contraindication to LT. The value of LT in the treatment of infantile haemangioendothelioma is more difficult to evaluate because of the very reduced number of reported cases and because of the often difficult differential diagnosis with angiosarcoma. LT should be reserved to those children not responding to medical treatment on the condition that sarcomatous modifications are excluded by expert pathologists to avoid a futile transplant procedure.
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Affiliation(s)
- Eliano Bonaccorsi-Riani
- Th STARZL Abdominal Transplant Unit, Department of Abdominal and Transplantation Surgery, University Hospitals St Luc, Université Catholique de Louvain, Belgium, Brussels
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39
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Liang X, Xiao-Min S, Jiang-Ping X, Jie-Yu Y, Xiao-Jun Z, Zhi-Ren F, Guo-Shan D, Rui-Dong L. Liver transplantation for primary hepatic leiomyosarcoma: a case report and review of the literatures. Med Oncol 2009; 27:1269-72. [PMID: 19997990 DOI: 10.1007/s12032-009-9372-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 11/16/2009] [Indexed: 12/24/2022]
Abstract
Primary hepatic leiomyosarcoma (PHL), a malignant mesenchymal tumor of myogenic origin, is exceedingly rare. Patients may be afflicted with a wide spectrum of nonspecific symptoms, and most of the laboratory data are unhelpful to diagnosis. Here, we report a 44-year-old woman with anorexia and right upper quadrant pain who was diagnosed as having malignant hepatic tumor within the Milan criteria and treated by orthotopic liver transplantation (OLT), the pathologic diagnosis of PHL was made by postoperative immunohistochemical study. She underwent six courses of intravenous chemotherapy and enjoyed a 14-month tumor recurrence-free survival until the lymph node metastasis was detected, then we switched the tacrolimus to sirolimus and the patient survived for 20 months additionally. Unfortunately, she finally died of extensively lymphatic metastasis and cachexia. The diagnostic and therapeutic features of PHL are also discussed by reviewing the literatures. To our knowledge, this is the second report of administering OLT to PHL patients.
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Affiliation(s)
- Xiao Liang
- Department of Liver Transplantation, Shanghai Changzheng Hospital, 415 Fengyang Road, 200003, Shanghai, People's Republic of China
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40
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Diagnosis and multi-disciplinary management of hepatic metastases from gastrointestinal stromal tumour (GIST). Eur J Surg Oncol 2009; 35:787-92. [PMID: 19185444 DOI: 10.1016/j.ejso.2009.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 12/25/2008] [Accepted: 01/06/2009] [Indexed: 12/13/2022] Open
Abstract
AIM To explore the present application of diagnosis and management of hepatic metastases from GIST. METHODS We performed a systematic review of the literature for studies concerning hepatic metastases from GIST. A literature search was performed using the Medline/PubMed databases to identify publications relevant to the review published from January 1998 to December 2008. Totally 113 relevant articles were retrieved. Abstracts from recent ASCO symposia were hand searched for relevant articles. After the primary filtration, articles on review and with repetitive content were excluded. The articles on clinical research, which were issued in authorized journals, were selected. At last, totally 69 articles were included for review. FINDINGS The rate of liver metastases was reported as 15.9% in primary GISTs. The recurrence rate following surgical resection for hepatic metastases from GIST had been reported as 70-77%. For metastatic GIST patients with tyrosine kinase inhibitor (TKI) treatment, it demonstrated rates of CR, PR and SD respectively of 5.84%, 50.7%, and 32.4%. Combining repeated surgery with TKI treatment, R0/R1 resection rates range in various series between 48 and 82%. For those patients with unresectable disease confined to the liver or unable to tolerate liver resection due to co-morbidity or advanced age, RFA, HACE, TKI therapy, or even liver transplantation, can also improve survival. CONCLUSIONS The liver is a common metastatic site for gastrointestinal stromal tumour (GIST). Appropriate initial evaluation remains paramount for selecting the correct management strategy. Multi-disciplinary management (which includes pathology, medical oncology, surgical oncology, and imaging expertise) of this disease is important for both curative and palliative treatment in these patients. Combining repeated surgery with TKI treatment may be the most effective management for GIST patients with liver metastases.
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41
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Bhati CS, Bhatt AN, Starkey G, Hubscher SG, Bramhall SR. Acute liver failure due to primary angiosarcoma: a case report and review of literature. World J Surg Oncol 2008; 6:104. [PMID: 18826593 PMCID: PMC2567320 DOI: 10.1186/1477-7819-6-104] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 09/30/2008] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepatic angiosarcoma is a primary sarcoma of the liver, accounting for only 2% of all primary hepatic malignancies. Acute liver failure is an extremely rare presentation of a primary liver tumour. CASE PRESENTATION We report a case of a seventy year-old man who presented with a very short period of jaundice leading to fulminant hepatic failure (FHF). On further investigation he was found to have primary angiosarcoma of liver. CONCLUSION The treatment outcomes for hepatic angiosarcoma are poor, we discuss the options available and the need for prompt investigation and establishment of a diagnosis.
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Lerut JP, Weber M, Orlando G, Dutkowski P. Vascular and rare liver tumors: a good indication for liver transplantation? J Hepatol 2007; 47:466-75. [PMID: 17697721 DOI: 10.1016/j.jhep.2007.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jan P Lerut
- Abdominal Transplant Unit, Department of Abdominal and Transplantation Surgery, University Hospitals St. Luc, Brussels, Belgium
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43
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Menéndez P, Cubo T, Padilla D, Villarejo P, Gambí D, López R, Martín J, Pardo R, de la Plaza R, Jara A, Menchén B, Martínez F, Gil A, López A, Molina JM, Manzanares C, Menéndez Rubio JM. [Microcytic and hypochromic anemia due to a high-grade undifferentiated, embryonal, pleomorphic sarcoma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:391-4. [PMID: 17692196 DOI: 10.1157/13108808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Undifferentiated (embryonal) sarcoma (UES) of the liver is a primary malignant tumor, rarely diagnosed in adults. Because of the absence of specific symptoms, rapid tumor growth, and normality of the common tumor markers, this neoplasm has a poor prognosis. Histologically, UES of the liver is characterized by anaplastic cells within myxoid matrix. Histological, immunohistochemical and chromosomic alterations are similar in UES and in mesenchymal hamartoma, suggesting a relation between these entities. The mainstay of treatment is surgery, while adjuvant treatment could increase survival.
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Affiliation(s)
- Pablo Menéndez
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General de Ciudad Real, Ciudad Real, España.
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Dougherty M, Bonatti H, Dickson RC, Aranda-Michel J, Hinder R, Nguyen J, Steers J, Hughes CB. Management of metastatic gastrointestinal stromal tumor by multiple surgical interventions including pancreatoduodenectomy, liver resection and two liver transplants: worth the effort? Eur Surg 2007. [DOI: 10.1007/s10353-007-0327-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Gastrointestinal stromal tumors (GISTs) are clinically diagnosed by positive immunohistochemical staining of KIT, a type III receptor tyrosine kinase. Most GISTs contain gain-of-function, ie, oncogenic mutations in c-KIT or in platelet-derived growth factor receptor-alpha (PDGFR-alpha), which appears to be the major initiating event that drives the pathogenesis for GIST. Furthermore, mutations in either of these genes appear to be required for tumor growth and progression. This scenario can be thought of as "oncogenic addiction" and is one of the major reasons why some GISTs respond significantly to therapies that target these mutant receptors. In addition to mutations in c-KIT or PDGFR-alpha, genomic alterations contribute to disease progression. Moreover, GISTs that harbor different c-KIT or PDGFR-alpha mutations have different molecular signatures at the level of gene expression, which further contributes to the complexity of GIST biology and variable responses to treatment. This article will discuss the molecular basis of pathogenesis and genetic and genomic alterations that contribute to GIST tumorigenesis and disease progression as well as the heterogeneity of this disease.
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Affiliation(s)
- Chi Tarn
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Gomez D, Al-Mukthar A, Menon K, Toogood G, Lodge J, Prasad K. Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours: a single centre experience. HPB (Oxford) 2007; 9:64-70. [PMID: 18333115 PMCID: PMC2020776 DOI: 10.1080/13651820601156108] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND The outcome of surgical intervention for hepatic metastases from gastrointestinal stromal tumours (GIST) is still uncertain. This study evaluated the outcome of patients following aggressive surgical resection and Imatinib mesylate therapy (IM). PATIENTS AND METHODS This was a retrospective analysis of patients managed with hepatic metastases from GIST over a 13-year period (January 1993 to December 2005). RESULTS Twelve patients were identified with a median age at diagnosis of 62 (32-78) years. The primary sites of GIST were stomach (n=5), jejunum (n=4), sigmoid (n=1), peritoneum (n=1) and pancreas (n=1). Eleven patients underwent surgical resection with curative intent and one patient had cytoreductive surgery. Following surgery with curative intent (n=11), the overall 2- and 5-year survival rates were both 91%, whereas the 2- and 5-year disease-free rates following primary hepatic resection were 30% and 10%, respectively. The median disease-free period was 17 (3-72) months. Eight patients had recurrent disease and were managed with further surgery (n=3), radiofrequency ablation (RFA) (n=2) and IM (n=8). Overall, there are four patients who are currently disease-free: two patients following initial hepatic resection and two patients following further treatment for recurrent disease. There was no significant association in clinicopathological characteristics between patients with recurrent disease within 2 years and patients who were disease-free for 2 years or more. Overall morbidity was 50% (n=6), with one postoperative death. The follow-up period was 43 (3-72) months. CONCLUSION Surgical resection for hepatic GIST metastases may improve survival in selected patients. Recurrent disease can be managed with surgery, RFA and IM.
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Affiliation(s)
- D. Gomez
- Hepatobiliary and Transplantation Unit, Leeds Teaching Hospitals NHS TrustLeedsUK
| | - A. Al-Mukthar
- Hepatobiliary and Transplantation Unit, Leeds Teaching Hospitals NHS TrustLeedsUK
| | - K.V. Menon
- Hepatobiliary and Transplantation Unit, Leeds Teaching Hospitals NHS TrustLeedsUK
| | - G.J. Toogood
- Hepatobiliary and Transplantation Unit, Leeds Teaching Hospitals NHS TrustLeedsUK
| | - J.P.A. Lodge
- Hepatobiliary and Transplantation Unit, Leeds Teaching Hospitals NHS TrustLeedsUK
| | - K.R. Prasad
- Hepatobiliary and Transplantation Unit, Leeds Teaching Hospitals NHS TrustLeedsUK
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