Primary pleomorphic liposarcoma of liver: a case report and review of the literature.Case Reports Hepatol. 2013;2013:398910. [PMID: 25374715 DOI: 10.1155/2013/398910]

Primary pleomorphic liposarcoma of the liver: a case report and literature review

Background

Primary liposarcoma arising from the liver is exceedingly rare. There have been very few reports documenting primary hepatic liposarcoma, especially of the pleomorphic subtype. Surgery is currently the only established treatment method, and the prognosis remains poor. In this report, we present an unusual case of hepatic liposarcoma of the pleomorphic subtype with literature review. In addition, we discuss theories regarding pathogenesis and the pathological and clinical features of primary hepatic liposarcoma to better outline this rare entity.

Case presentation

An asymptomatic 65-year-old female was found to have a right hepatic mass on a computed tomography scan 2 years after surgical resection of the left adrenal gland and kidney for adrenocortical carcinoma. Laboratory examinations were unremarkable. Magnetic resonance imaging demonstrated a 16-mm mass in the right hepatic lobe. Adrenocortical carcinoma metastasis was suspected. Laparoscopic partial hepatectomy completely removed the tumor with clear margins. Macroscopically, the surgical specimen contained a nodular, yellow–white mass lesion 20 mm in diameter. On pathologic examination, pleomorphic, spindle-shaped tumor cells containing hypochromatic, irregularly shaped nuclei of various sizes formed fascicular structures. Scattered lipoblasts intervened in varying stages. Mitotic cells were frequent. Ki-67 labeling index was 15%. Immunohistochemically, the tumor cells were diffusely positive for vimentin and focally positive for CD34 and alpha-SMA; lipoblasts were focally positive for S-100. Tumor cells were nonreactive for SF-1, inhibin alpha, desmin, HHF35, HMB45, Melan A, MITF, c-kit, DOG1, cytokeratin AE1/AE3, h-caldesmon, STAT6, CD68, MDM2, CDK4, c17, DHEAST, 3BHSD, CD31, Factor 8, and ERG. From these findings, primary hepatic liposarcoma of pleomorphic subtype was diagnosed. The tumor recurred intrahepatically 3 years later, and the patient died 5 months after recurrence.

Conclusions

In our report, we discussed the rarity, theories regarding pathogenesis, and a review of the literature of this atypical condition. To the best of our search, this is the 14th case of primary hepatic liposarcoma and the 2nd case of the pleomorphic subtype reported throughout the world. Further research regarding the etiology of this unusual clinical entity is warranted to establish effective diagnostic and management protocols.

Indeterminate liver lesions on gadoxetic acid-enhanced magnetic resonance imaging of the liver: Case-based radiologic-pathologic review

Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology. It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently, but also certain benign lesions have differing management. These lesions are increasingly being detected due to rapid growth of use of cross-sectional imaging as well as improvement in image quality and new imaging techniques. Contrast enhanced magnetic resonance imaging (MRI) is considered the gold standard technique in characterising focal liver lesions. Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities. Classic imaging characteristics of common liver lesions, including their behaviour on gadoxetic acid enhanced MRI, have been described in literature over recent years. It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis. In this article, we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting, namely hepatocellular adenoma, focal nodular hyperplasia, hepatic angiomyolipoma, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.

Primary pleomorphic liver liposarcoma: A case series and literature review

Primary hepatic liposarcoma is an extremely rare mesenchymal tumor that accounts for only 0.1% to 2% of primary malignant liver tumors. Due to its rarity, there is a lack of knowledge about its clinical course, management, and prognosis. Only 15 cases of primary liposarcoma of the liver have been reported since 1973. Among these 15 cases, only two involved primary liver liposarcoma with a pleomorphic subtype. Here we report the third and fourth cases of primary pleomorphic liver liposarcoma. A 57-year-old female presented with abdominal discomfort and progressive abdominal distension for two weeks. Computed tomography (CT) of her abdomen revealed a large well-defined solid nodule mass with an area of necrosis and hemorrhage occupying segment IV-B of the liver. Wide local excision was performed. She had an uneventful recovery and remained well at six months post-treatment. A 65-year-old male presented with an abdominal mass for two-month. CT demonstrated a mass in the left lobe of the liver with mixed soft tissues and fat attenuation. He underwent wide local excision. He was discharged on day three postoperatively. Histological analysis for both cases revealed liposarcoma of the liver with a pleomorphic subtype.

Positron emission tomography/computed tomography manifestations of primary hepatic myxoid liposarcoma: A case report

RATIONALE

Computed tomography (CT) and magnetic resonance imaging (MRI) are conventional used to evaluate liver tumors. Detection of fat component is considered an important clue to the imaging diagnosis of hepatic myxoid liposarcoma. However, the positron emission tomography (PET)/CT report of hepatic myxoid liposarcoma is scarce, and the metabolic characteristics of primary hepatic myxoid liposarcoma are still unknown.

PATIENT CONCERNS

In this report, we report the PET/CT manifestations of a rare case of primary hepatic myxoid liposarcoma that was confirmed by pathologic examination. A 29-year-old male patient presented with a nodule adjacent to the umbilicus that had been present for 2 weeks. PET/CT showed a hypoattenuating mass with moderate uptake (maximum standardized uptake value [SUVmax] 1.9), except for a slightly hyperattenuating focal area with intense uptake (SUVmax 3.1).

DIAGNOSES

The final pathologic diagnosis was confirmed, by means of laparotomy, to be a primary hepatic myxoid liposarcoma with multiple extrahepatic metastases.

INTERVENTIONS

The lesions in the left liver and periumbilical abdominal wall were punctured. During the laparotomy, hepatic malignant tumors were confirmed and metastasized widely in the abdominal cavity.

OUTCOMES

An abdominal CT performed 4 months after initial presentation showed extensive metastasis.

LESSONS

Primary hepatic myxoid liposarcoma may manifest as moderate metabolism with less fat on PET/CT. PET/CT is not only valuable in reflecting the round cell component of hepatic myxoid liposarcoma, but also in estimating its origin.

[Undifferentiated liver liposarcoma: about a case]

Le liposarcome est une tumeur mésenchymateuse maligne rare, qui siège plus fréquemment au niveau du retro péritoine. La localisation hépatique est extrêmement rare, quelques cas ont été rapportés dans la littérature. Nous présentons le cas d'un un patient de 58 ans, qui se présente pour douleurs abdominales avec à la palpation une masse de hypochondre droit, ayant progressivement augmenté de taille. L'échographie abdominale a montré une masse arrondie, hyper échogène bien limitée. La tomodensitométrie(TDM) abdominale et l'imagerie par résonnance magnétique(IRM) ont confirmé la présence d'une masse qui occupe presque la totalité du foie droit, avec une composante graisseuse. Le patient a bénéficié d'une hépatectomie droite et l'analyse histologique a montrée qu'il s'agissait d'un liposarcome hépatique primitif dédifférencié.