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Depauw L, De Weerdt G, Gys B, Demeulenaere S, Mebis W, Ysebaert D. Pediatric fibrolamellar hepatocellular carcinoma: case report and review of the literature. Acta Chir Belg 2021; 121:204-210. [PMID: 34082642 DOI: 10.1080/00015458.2019.1660060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND A 13-year-old boy presented with acute abdominal pain in the right upper quadrant without previous trauma. Abdominal ultrasound (US) revealed a mass in the right liver lobe with free intraperitoneal fluid, suggestive for hemoperitoneum. Magnetic resonance imaging confirmed a subcapsular lesion (5.7 × 4.6 × 4.1 cm), suggestive for fibrolamellar hepatocellular carcinoma (FL-HCC). Positron emission tomography-computed tomography revealed mild to moderate fluorodeoxyglucose (FDG) avidity, with no other FDG avid lesions. Hepatic tumor markers were negative. CASE REPORT An elective right hepatectomy with cholecystectomy and hilar lymph node resection was performed. RESULTS Histology showed a central fibrous scar and confirmed a FL-HCC (pT1bN0M0). The resected lymph nodes were tumor-free. Treatment of FL-HCC should consist of complete tumor resection with concurrent lymph node resection +/- orthotopic liver transplantation. Long-term follow-up is advised. A follow-up interval of 3-4 months in the first 2 years after surgical resection can be justified as FL-HCC have a high recurrence rate of more than 50% within 10-33 months. CONCLUSIONS Malignancy can be a rare cause of abdominal pain in pediatric patients. An abdominal US is essential to prevent misdiagnosis. Treatment of FL-HCC should consist of R0 tumor resection with concurrent lymphadenectomy +/- orthotopic liver transplantation.
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Affiliation(s)
- Laura Depauw
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Glenn De Weerdt
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Ben Gys
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Sofie Demeulenaere
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Wouter Mebis
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Dirk Ysebaert
- Department of Hepatobiliairy Surgery, Antwerp University Hospital, Antwerp, Belgium
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2
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Razik A, Malla S, Goyal A, Gamanagatti S, Kandasamy D, Das CJ, Sharma R, Gupta AK. Unusual Primary Neoplasms of the Adult Liver: Review of Imaging Appearances and Differential Diagnosis. Curr Probl Diagn Radiol 2020; 51:73-85. [PMID: 33199074 DOI: 10.1067/j.cpradiol.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/16/2020] [Indexed: 12/24/2022]
Abstract
The radiological appearance of common primary hepatic tumors such as hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) is widely recognized. Hepatic masses with unusual histology are occasionally encountered, but seldom suspected on imaging. However, many possess characteristic imaging findings, which when assessed along with the clinical and demographic background and serum tumor markers, may enable a prospective diagnosis. This review attempts to familiarize the reader with the clinicopathological characteristics, imaging manifestations, and differential diagnosis of these unusual liver tumors in adults. Biphenotypic primary liver carcinoma is suspected in masses showing distinct areas of HCC and CCA-type enhancement pattern in cirrhotic livers. Fibrolamellar carcinoma occurs in young individuals without underlying chronic liver disease and shows a characteristic T2-hypointense scar frequently showing calcification. Perivascular epithelioid cell tumors are differentials for any arterial hyperenhancing mass in the noncirrhotic liver, particularly in patients with tuberous sclerosis. Multifocal subcapsular tumors showing target-like morphology, capsular retraction and "lollipop" sign are suspicious for epithelioid hemangioendothelioma. On the other hand, multiple hemorrhagic lesions showing patchy areas of bizarre-shaped arterial phase hyperenhancement are suspicious for angiosarcoma. Primary hepatic lymphoma (PHL) is suspected when patients with immunosuppression present with solitary or multifocal masses that insinuate around vessels and bile ducts without causing luminal narrowing. Intense diffusion restriction and low-level homogeneous or target-like enhancement are also ancillary features of PHL. Primary hepatic neuroendocrine tumor shows uptake on Ga-68 DOTANOC PET/CT. Although a straightforward diagnosis may be difficult in these cases, awareness of the characteristic imaging appearances is helpful in suspecting the diagnosis.
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Affiliation(s)
- Abdul Razik
- Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - Sundeep Malla
- Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | | | - Chandan Jyoti Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India.
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
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3
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Matsunaga Y, Ariizumi S, Shibuya G, Uemura S, Kato T, Yazawa T, Yamashita S, Omori A, Higuchi R, Takahashi Y, Kotera Y, Egawa H, Yamamoto M. Hepatocellular carcinoma with ring calcification mimicking hydatid disease: a case report. Surg Case Rep 2020; 6:171. [PMID: 32661725 PMCID: PMC7359204 DOI: 10.1186/s40792-020-00927-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/26/2020] [Indexed: 01/23/2023] Open
Abstract
Background Ring calcification in hepatocellular carcinoma is extremely rare. Untreated hepatocellular carcinoma occasionally includes calcified lesions. Here, we report a case of ring-calcified hepatocellular carcinoma. Case presentation A 60-year-old man with a hepatic tumor was referred to Tokyo Women’s Medical University Hospital. He had a history of chronic hepatitis C. Computed tomography showed a liver tumor 20 mm in diameter in segment 6 of the Couinaud classification, with ring calcification. Based on this uncommon imaging presentation and the patient’s past exposure to the definitive hosts of Echinococcus multilocularis, he was preoperatively diagnosed with echinococcosis. Partial hepatectomy was performed as a radical treatment for echinococcosis. A final diagnosis of hepatocellular carcinoma was confirmed based on pathological findings. The patient was discharged uneventfully. Conclusion The presentation of an extremely rare hepatocellular carcinoma with ring calcification may be disguised as hydatid disease.
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Affiliation(s)
- Yutaro Matsunaga
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Shunichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Go Shibuya
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Shuichiro Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Takaaki Kato
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Shingo Yamashita
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Akiko Omori
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yutaka Takahashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yoshihito Kotera
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan.
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4
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Lemekhova A, Hornuss D, Polychronidis G, Mayer P, Rupp C, Longerich T, Weiss KH, Büchler M, Mehrabi A, Hoffmann K. Clinical features and surgical outcomes of fibrolamellar hepatocellular carcinoma: retrospective analysis of a single-center experience. World J Surg Oncol 2020; 18:93. [PMID: 32397993 PMCID: PMC7218513 DOI: 10.1186/s12957-020-01855-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
Abstract
Background Clinicopathological features and surgical outcomes of patients with fibrolamellar hepatocellular carcinoma (FL-HCC) are underreported. The aim of this study is to describe clinical characteristics and surgical outcomes for patients with this rare tumor to raise awareness among clinicians and surgeons. Methods Retrospective review of records of a tertiary referral center and specialized liver unit was performed. Out of 3623 patients who underwent liver resection, 366 patients received surgical treatment for HCC; of them, eight (2.2%) had FL-HCC and were resected between October 2001 and December 2018. Results Eight patients (3 males and 5 females) with FL-HCC (median age 26 years) underwent primary surgical treatment. All patients presented with unspecific symptoms or were diagnosed as incidental finding. No patient had cirrhosis or other underlying liver diseases. Coincidentally, three patients (37.5%) had a thromboembolic event prior to admission. The majority of patients had BCLC stage C and UICC stage IIIB/IVA; four patients (50%) presented with lymph node metastases. The median follow-up period was 33.5 months. The 1-year survival was 71.4%, and 3-year survival was 57.1%. Median survival was at 36.4 months. Five patients (62.5%) developed recurrent disease after a median disease-free survival of 9 months. Two patients (25.0%) received re-resection. Conclusion FL-HCC is a rare differential diagnosis of liver masses in young patients. Since the prognosis is limited, patients with incidental liver tumors or lesions with suspicious features in an otherwise healthy liver should be presented at a specialized hepatobiliary unit. Thromboembolism might be an early paraneoplastic symptom and needs to be elucidated further in the context of FL-HCC.
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Affiliation(s)
- Anastasia Lemekhova
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karls University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany
| | - Daniel Hornuss
- Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany.,Department of Gastroenterology and Hepatology, Ruprecht Karls University Hospital, Heidelberg, Germany
| | - Georgios Polychronidis
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karls University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany
| | - Philipp Mayer
- Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Ruprecht Karls University Hospital, Heidelberg, Germany
| | - Christian Rupp
- Department of Gastroenterology and Hepatology, Ruprecht Karls University Hospital, Heidelberg, Germany
| | - Thomas Longerich
- Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany.,Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Karl-Heinz Weiss
- Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany.,Department of Gastroenterology and Hepatology, Ruprecht Karls University Hospital, Heidelberg, Germany
| | - Markus Büchler
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karls University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karls University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral, and Transplantation Surgery, Ruprecht Karls University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,Liver Cancer Centre Heidelberg (LCCH), Heidelberg, Germany.
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5
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Tsuruta S, Kimura N, Ishido K, Kudo D, Sato K, Endo T, Yoshizawa T, Sukeda A, Hiraoka N, Kijima H, Hakamada K. Calcifying nested stromal epithelial tumor of the liver in a patient with Klinefelter syndrome: a case report and review of the literature. World J Surg Oncol 2018; 16:227. [PMID: 30453967 PMCID: PMC6245822 DOI: 10.1186/s12957-018-1528-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/12/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Calcifying nested stromal epithelial tumor (CNSET) is a primary neoplasm of the liver, characterized by well-demarcated nests consisting of spindle and epithelioid cells with calcification and bone formation. An association of Cushing syndrome with CNSET has drawn attention, but the origin of CNSET has not been clarified. CASE PRESENTATION We report here the case of a 20-year-old male with Klinefelter syndrome who underwent liver resection for an increasing liver tumor that was pathologically diagnosed with CNSET. He was postoperatively followed up and received several examinations, and recurrences and extrahepatic lymph node metastases were detected on the 64th day after surgery. Chemoembolization and chemotherapy were not effective, leading to tumor progression with development of progressive liver failure, and the patient finally died 164 days after hepatectomy. CONCLUSIONS This case suggests that an imbalance of hormones affects the genesis and progression of CNSET, and indicates the importance of closely following patients with CNSET by imaging with attention to hepatic recurrence and extrahepatic metastases.
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Affiliation(s)
- Satoru Tsuruta
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan
| | - Norihisa Kimura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan.
| | - Keinosuke Ishido
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan
| | - Daisuke Kudo
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan
| | - Kentaro Sato
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan
| | - Tetsu Endo
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan
| | - Tadashi Yoshizawa
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan
| | - Aoi Sukeda
- Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Nobuyoshi Hiraoka
- Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hiroshi Kijima
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5, Zaifu, Hirosaki, Aomori, 036-8562, Japan
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6
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Ho A, Girgis S, Low G. Uncommon liver lesions with multimodality imaging and pathology correlation. Clin Radiol 2018; 73:191-204. [DOI: 10.1016/j.crad.2017.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/16/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023]
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7
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Semelka RC, Nimojan N, Chandana S, Ramalho M, Palmer SL, DeMulder D, Parada Villavicencio C, Woosley J, Garon BL, Jha RC, Miller FH, Altun E. MRI features of primary rare malignancies of the liver: A report from four university centres. Eur Radiol 2017; 28:1529-1539. [PMID: 29079914 DOI: 10.1007/s00330-017-5102-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/12/2017] [Accepted: 09/27/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if rare primary malignancies of the liver may have consistent features on magnetic resonance imaging (MRI). MATERIALS AND METHODS This IRB-compliant retrospective study reviewed the records from the pathology departments of four university centres over an 11-year period from 2005-2016 to identify rare primary malignant tumours, which were cross-referenced with MRI records. MRI studies of these patients were reviewed to determine if these tumours exhibited consistent and distinctive features. RESULTS Sixty patients were identified with rare primary liver tumours. The following distinctive features and frequency of occurrence were observed: mixed hepatocellular carcinoma-cholangiocarcinoma showed regions of wash-out in 7/19 of patients; 6/6 of fibrolamellar carcinomas demonstrated large heterogeneous lesions with large heterogeneous central scars; epithelioid haemangioendothelioma larger than 2 cm showed target-like enhancement in late-phase enhancement in 9/13; sarcomas excluding angiosarcoma had central necrosis in 3/9 and haemorrhage in 5/9; angiosarcomas showed centripedal progressive nodular enhancement in 3/6 and showed regions of haemorrhage in 3/6; and 7/7 of primary hepatic lymphomas showed encasement of vessels. CONCLUSION Although helpful features for the differentiation of rare primary malignancies of the liver are identified, no MRI features appear to be specific and therefore histopathological confirmation is usually required for definitive diagnosis. KEY POINTS • No MRI features appear to be specific for rare primary liver malignancies. • Haemorrhage is a helpful sign in diagnosis of primary hepatic sarcomas. • Angiosarcomas may show progressive nodular enhancement towards the centre mimicking haemangioma. • Vessel encasement is a helpful sign in diagnosis of primary hepatic lymphoma.
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Affiliation(s)
- Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Nadesan Nimojan
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Saman Chandana
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Suzanne L Palmer
- Department of Radiology, University of South California, Los Angeles, CA, USA
| | | | | | - John Woosley
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bonnie L Garon
- Department of Radiology, University of South California, Los Angeles, CA, USA
| | - Reena C Jha
- Department of Radiology, Georgetown University, Washington, DC, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
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9
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Pugmire BS, Towbin AJ. Magnetic resonance imaging of primary pediatric liver tumors. Pediatr Radiol 2016; 46:764-77. [PMID: 27229495 DOI: 10.1007/s00247-016-3612-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/28/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
Although primary hepatic neoplasms are less common than other intra-abdominal tumors in children, these neoplasms are a significant source of morbidity and mortality in the pediatric population. MRI is increasingly relied upon in the diagnostic evaluation of these lesions, both before and after treatment, and familiarity with the MRI findings associated with these neoplasms is a must for pediatric radiologists. Advances in MRI technology, particularly the advent of hepatocyte-specific gadolinium-based MRI contrast agents, have allowed for accurate characterization of several types of hepatic neoplasms on the basis of imaging appearance. In this review, we provide an overview of the approach to imaging hepatic neoplasms in children using MRI, including a sample imaging protocol. We also discuss the relevant clinical features and MRI findings of the most clinically relevant entities, including their appearance on post-contrast imaging using hepatocyte-specific gadolinium-based MRI contrast agents.
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Affiliation(s)
- Brian S Pugmire
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA.
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10
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Schaffer LR, Shehata BM, Yin J, Schemankewitz E, Alazraki A. Calcifying nested stromal-epithelial tumor (CNSET) of the liver: a newly recognized entity to be considered in the radiologist's differential diagnosis. Clin Imaging 2015; 40:137-9. [PMID: 26589005 DOI: 10.1016/j.clinimag.2015.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 09/24/2015] [Accepted: 10/16/2015] [Indexed: 02/08/2023]
Abstract
Calcifying nested stromal-epithelial tumor (CNSET), an extremely rare tumor found in the liver, was first described in 2001 by Ishak et al. The characteristic imaging features include large size, well-circumscribed, enhancing mass with calcification. To our knowledge, since 2001, there have been 29 reported. Typically arising from the right hepatic lobe, it is primarily found in children and shows clear predilection for females. Emphasizing imaging, we report a 14-year-old female with Beckwith-Wiedemann syndrome who presented with CNSET.
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Affiliation(s)
- Lauren R Schaffer
- Children's Healthcare of Atlanta and Emory University, Department of Pathology
| | - Bahig M Shehata
- Children's Healthcare of Atlanta and Emory University, Department of Pathology
| | - Julie Yin
- Children's Healthcare of Atlanta and Emory University, Department of Pathology
| | - Erwin Schemankewitz
- Children's Healthcare of Atlanta and Emory University, Department of Pathology
| | - Adina Alazraki
- Children's Healthcare of Atlanta and Emory University, Departments of Pediatrics and Radiology and Imaging Sciences.
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11
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Diagnostic accuracy of 11C-choline PET/CT in comparison with CT and/or MRI in patients with hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2015; 42:1399-407. [DOI: 10.1007/s00259-015-3079-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/28/2015] [Indexed: 12/11/2022]
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12
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Arora R. Fibrolamellar hepatocellular carcinoma presenting as obstructive jaundice: uncommon presentation of a rare entity. Pol J Radiol 2015; 80:168-71. [PMID: 25866594 PMCID: PMC4386441 DOI: 10.12659/pjr.893039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/04/2014] [Indexed: 01/20/2023] Open
Abstract
Background Fibrolamellar hepatocellular carcinoma is a rare primary malignant liver tumor, significantly different from generic hepatocellular carcinoma with distinct demographics, risk factors, imaging features, histopathology and prognosis. Case Report Unlike conventional hepatocellular carcinoma, it presents in young individuals with no preexisting hepatitis or cirrhosis and does not cause elevation of serum alpha feto proteins in most cases. This paper presents a case report of this rare tumor in a young female with an unusual clinical manifestation of obstructive jaundice (which has not been reported so far) along with a review of its imaging and pathological features, with treatment options. Conclusions Fibrolamellar HCC is a rare variant of classic HCC with different epidemiology, risk factors, clinical manifestations, radiological, pathological and prognostic features. Therefore, it is important to be familiar with the entity for its early diagnosis and management.
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Affiliation(s)
- Richa Arora
- Department of Radiology, Nizams Institute of Medical Sciences, Hyderabad, India
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13
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Roumanis PS, Bhargava P, Kimia Aubin G, Choi JI, Demirjian AN, Thayer DA, Lall C. Atypical magnetic resonance imaging findings in hepatocellular carcinoma. Curr Probl Diagn Radiol 2015; 44:237-45. [PMID: 25823550 DOI: 10.1067/j.cpradiol.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Magnetic resonance imaging (MRI) is currently the modality of choice to evaluate liver lesions in patients with cirrhosis and hepatitis B and C. Hepatocellular carcinoma demonstrates typical imaging findings on contrast-enhanced MRI, which are usually diagnostic. Unfortunately, a subgroup of hepatocellular carcinoma presents with atypical imaging features, and awareness of these atypical presentations is important in ensuring early diagnosis and optimal patient outcomes. Herein, we review some of the more common atypical presentations with a focus on MRI.
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Affiliation(s)
| | - Puneet Bhargava
- Department of Radiology, University of Washington, School of Medicine, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA
| | - Golnaz Kimia Aubin
- Department of Radiological Sciences, University of California, Irvine, CA
| | - Joon-Il Choi
- Department of Radiological Sciences, University of California, Irvine, CA; Department of Radiology, Seoul St. Mary׳s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Aram N Demirjian
- Department of Hepatobiliary Surgery, University of California, Irvine, CA
| | - David A Thayer
- Department of Radiological Sciences, University of California, Irvine, CA
| | - Chandana Lall
- Department of Radiological Sciences, University of California, Irvine, CA.
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14
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Primary biliary tract malignancies: MRI spectrum and mimics with histopathological correlation. ACTA ACUST UNITED AC 2014; 40:1520-57. [DOI: 10.1007/s00261-014-0300-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Garrett R. Solid liver masses: approach to management from the standpoint of a radiologist. Curr Gastroenterol Rep 2013; 15:359. [PMID: 24243519 DOI: 10.1007/s11894-013-0359-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Solid liver masses are being discovered at increasing rates due to the widespread use of medical imaging. Ultrasound, computed tomography, and magnetic resonance imaging play important and often complementary roles in detecting and diagnosing solid liver masses. Morphologic and enhancement characteristics as well as clinical history frequently allow a confident imaging diagnosis. Still, diagnosing liver masses with imaging alone remains a challenge, and masses that do not meet specific diagnostic criteria may require biopsy. Newly developed standardized terminology and imaging criteria have facilitated the imaging diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. Hepatobiliary-secreted MRI contrast agents have improved the ability to diagnose focal nodular hyperplasia and may also improve the detection and imaging diagnosis of HCC. These exciting new contrast agents are the subject of active investigation.
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Affiliation(s)
- Robert Garrett
- Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, Saint Louis, MO, 63110, USA,
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De Gaetano AM, Nure E, Grossi U, Frongillo F, Russo R, Vecchio FM, Lirosi MC, Sganga G, Felice C, Bonomo L, Agnes S. Fibrolamellar hepatocellular carcinoma with biliary tumor thrombus: an unreported association. Jpn J Radiol 2013; 31:706-12. [PMID: 23852711 DOI: 10.1007/s11604-013-0233-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/02/2013] [Indexed: 02/06/2023]
Abstract
Fibrolamellar hepatocellular carcinoma (FHCC) is a rare malignant tumor of hepatocyte origin occurring earlier in life than typical hepatocellular carcinoma (HCC). We describe a distinctive case of FHCC with biliary tumor thrombus (BTT) in a 25-year-old Caucasian patient, pointing out the imaging features supported by histopathology.
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Affiliation(s)
- Anna Maria De Gaetano
- Department of Bio-Sciences and Radiological Imaging, Catholic University of the Sacred Heart, Rome, Italy
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High aromatase activity and overexpression of epidermal growth factor receptor in fibrolamellar hepatocellular carcinoma in a child. J Pediatr Hematol Oncol 2011; 33:e195-7. [PMID: 21552145 DOI: 10.1097/mph.0b013e3182011676] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An 11-year-old boy was admitted with a liver tumor and underwent right trisegmentectomy for a diagnosis of fibrolamellar hepatocellular carcinoma. He had suffered from bilateral gynecomastia for a year, which improved after complete resection of the tumor. The tumor cells had significant aromatase activity (8.03 pmol/g/h) and contained high levels of estradiol (82.1 pg/mL), which contributed to gynecomastia. Furthermore, overexpression of epidermal growth factor receptor was determined in the tumor cells, which suggests that antitumor strategies using epidermal growth factor receptor antagonists may be effective.
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Abstract
Recent advances in multidetector-row computed tomography, magnetic resonance imaging, and ultrasonography have led to the detection of incidental hepatic lesions in both the oncology and nononcology patient population that in the past remained undiscovered. These incidental hepatic lesions have created a management dilemma for both clinicians and radiologists. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidentalomas are presented.
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