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Qu J, Cao Q, Zhang M, Liu Y, Li J. Primary hepatic undifferentiated pleomorphic sarcoma co-existing with hepatocellular carcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:450-451. [PMID: 37882154 DOI: 10.17235/reed.2023.9977/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
A 60-year-old man presented with a 1-month history of lacking in strength. He had a history of hepatitis B. Laboratory evaluation revealed the following: alpha fetoprotein, 7.05 ng/mL (normal level, 0-7.00 ng/mL); neuron-specific enolase, 52.20 ng/mL (normal level, 0-20.00 ng/mL). Other tumor markers were normal, including carcinoembryonic antigen and cancer antigen 199. Abdominal MR demonstrated a 1.5 cm diameter nodule and a 7.0 cm diameter mass, both with inhomogeneous hyperintensities on T2WI, fat-suppressed T2WI and diffusion weighted image. After Gd-EOB-DTPA enhancement, the small nodule showed rapid enhancement at arterial phase and washout at portal venous phase, with decrease in Gd-EOB-DTPA uptake at hepatobiliary phase. The big mass showed rim-like enhancement at arterial phase and portal venous phase, with similar decrease in Gd-EOB-DTPA uptake at hepatobiliary phase. Partial hepatectomy was performed and pathological examination of the tissues indicated that the small nodule was highly differentiated hepatocellular carcinoma. However, a gross examination of the big mass revealed grayish white solid tissue. The mass was finally diagnosed as undiferentiated pleomorphic sarcoma, with immunohistochemical results as follows: CKpn (-), Vimentin (+), Glypican3 (-), HepPar-1 (-), CK19 (-), S-100 (-), SMA (-), Desmin (-), MyoD1 (-), Myogenin (-), caldesmon (+), CD117 (-), D0 g-1 (-), CD34 (-), CD99 (+), CD68 (+), CD56 (-), CD21 (-), CD23 (-), EMA (-), S0X-10 (-), Melan-A (+), Ki67 (60%+). The patient was feeling well at 1 month of follow-up.
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Affiliation(s)
| | - Qinghua Cao
- Pathology, Yantai Affiliated Hospital of Binzhou Medical University
| | | | | | - Jun Li
- Radiology, Yantai Affiliated Hospital of Binzhou Medical University, China
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Sun H, Ge B, Li J. Primary hepatic undiferentiated pleomorphic sarcoma with recurrence and widespread metastasis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38235701 DOI: 10.17235/reed.2024.10215/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
A 59-year-old man was referred to us for evaluation of asymptomatic mass in the liver that had been detected on ultrasonography performed during a physical screening. He had no history of hepatitis, and was otherwise well. Tumor markers were normal, including alpha fetoprotein, carcinoembryonic antigen, neuron-specific enolase and cancer antigen 199. Abdominal CT showed a 5.0 cm diameter low density mass in the S6 segment of his liver, with mild peripheral enhancement. Abdominal MR demonstrated the mass with hypointensity on T1WI, inhomogeneous hyperintensity on fat-suppressed T2WI, and mild peripheral enhancement. Partial hepatectomy was performed and pathological examination indicated undiferentiated pleomorphic sarcoma, with immunohistochemical results as follows: Vimentin (+), CK (-), CD68 (+), INI-1 (+), Hepa (-), Gly-3 (-), Arg-1 (-), HMB45 (-), CAM5,2 (-), CD31 (-), CD34 (-), CK7 (-), CK19 (-),Desmin (-), SMA (+), EMA (-), S-100 (-), Ki67 (50%+). The patient underwent postoperative chemotherapy with karelizumab and gemcitabine. However, repeat MR 3 months later showed multiple nodules with rim-like enhancement around the surgical margin. Subsequent repeat CT 6 months later reveled marked progression of the lesions.
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Affiliation(s)
- Huabo Sun
- Gastroenterology, Yantai Affiliated Hospital of Binzhou Medical University
| | - Bingchang Ge
- School of Medical Imaging, Binzhou Medical University
| | - Jun Li
- Radiology, Yantai Affiliated Hospital of Binzhou Medical University, China
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Tomioka A, Asakuma M, Kawaguchi N, Komeda K, Shimizu T, Uchiyama K, Lee SW. Long-term disease-free survival of an undifferentiated pleomorphic sarcoma of the spleen: A case report and literature review. Medicine (Baltimore) 2022; 101:e31642. [PMID: 36451413 PMCID: PMC9704966 DOI: 10.1097/md.0000000000031642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Undifferentiated pleomorphic sarcoma (UPS) primarily occurs in the soft tissues of the extremities, trunk, and retroperitoneum. As the primary UPS of the spleen (splenic UPS) is extremely rare, to the best of our knowledge, only 19 cases have been reported in English literature. No cases of long-term survival without a local or distant recurrence have been reported. PATIENT CONCERNS We report the case of a 37-year-old man who was referred to our hospital for a splenic tumor. He had no past medical or relevant familial history. On abdominal computed tomography (CT), a low attenuation solid mass and cystic component with mural calcifications were present at the lower pole of his spleen. The fluorodeoxyglucose-positron emission tomography (CT) indicated it as malignant tumor of the spleen. DIAGNOSES The patient's provisional diagnosis was deduced to be angiosarcoma, which was the most common malignant tumor of the spleen. INTERVENTIONS An elective laparoscopic splenectomy was performed, and the histology of the tumor was consistent with UPS (pT1, pN0, cM0, and AJCC8th). No adjuvant therapy was administered. OUTCOMES Ten years have passed since the patient's splenectomy, and he continues to do well, without evidence of local or distant recurrence. LESSONS To the best of our knowledge, this is the first case of long-term recurrence-free survival after surgical management of a splenic UPS. It is probable that radical splenectomy during the disease played the most important role in the patient's long-term survival. Understanding the characteristic findings of a splenic UPS in an abdominal CT may help to diagnose properly.
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Affiliation(s)
- Atsushi Tomioka
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
- * Correspondence: Atsushi Tomioka, General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-cho, Takatsuki City, Osaka 569-8686, Japan. (e-mail: )
| | - Mitsuhiro Asakuma
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Nao Kawaguchi
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Koji Komeda
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Tetsunosuke Shimizu
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kazuhisa Uchiyama
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Sang-Woong Lee
- General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
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Pellegrini JR, Russe-Russe JR, Higgins TW, Prasandhan S, Khan N. Undifferentiated Hepatic Sarcoma: A Rare Case. Cureus 2022; 14:e25895. [PMID: 35844313 PMCID: PMC9278794 DOI: 10.7759/cureus.25895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 12/02/2022] Open
Abstract
Primary hepatic undifferentiated pleomorphic sarcoma (UPS) is a rare malignant mesenchymal tumor with a nonspecific clinical and radiologic presentation. Primary hepatic UPS is often a diagnosis of exclusion made by multiple immunohistological testing that rules out hepatic, hematologic, neural, and epithelial origin. Stains for mesenchymal origin are usually the only positive stain and do not demonstrate evidence of specific mesenchymal cell differentiation. We report a case of a 56-year-old male with no significant past medical history that presented with complaint of epigastric abdominal pain of six months duration. A computed tomography (CT) scan of the abdomen and pelvis exhibited numerous hepatic masses involving right and left hepatic lobe. A CT-guided core needle biopsy discovered undifferentiated/pleomorphic sarcoma. Histomorphology showed spindle cell neoplasm without recognizable hepatic tissue. Immunohistochemistry (IHC) stains were positive for smooth muscle actin (SMA) but failed to establish a more specific histogenesis. Furthermore, IHC stains revealed spindle neoplastic cells with focal and patchy positive h-caldesmon (approximately 10-15% of neoplastic cells), and negative for desmin. Given these results, the diagnosis of undifferentiated/pleomorphic sarcoma was established. It is imperative to consider UPS in the differential diagnosis of large liver lesions without evidence of differentiation. Early identification of this rare tumor can prevent the possibility of distant metastasis and improve survival among patients.
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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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Tohyama T, Tamura K, Takai A, Nishimura K, Kido T, Takada Y. Transmediastinal, intrapericardial inferior vena cava approach based on anatomical landmarks for hepatectomy using total hepatic vascular exclusion. Langenbecks Arch Surg 2021; 407:391-400. [PMID: 34427752 DOI: 10.1007/s00423-021-02246-1] [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: 01/27/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Total hepatic vascular exclusion (THVE) is an essential technique to control hemorrhage during surgical treatment of advanced liver tumors or injury. However, surgeons often have difficulty securing the intrapericardial inferior vena cava (IVC) because few reports have described the anatomy around the supra-diaphragmatic IVC or the techniques and surgical outcomes for this procedure. This study presents our safe and feasible intrapericardial IVC approach, which is based on anatomical landmarks, and reports the surgical outcomes of this procedure. METHODS We performed THVE using our technique for hepatectomy, accompanied by resection of the hepatic vein confluence or tumor thrombectomy of the supra-hepatic IVC, in five patients between August 2011 and March 2018. RESULTS The mean operative time was 568 min (range: 240-820 min). The mean THVE time was 10 min (range: 5-15 min), with a mean blood loss of 1882 mL (range: 1010-3100 mL). Postoperatively, one patient was classified as Clavien-Dindo grade II due to medication for tachycardia, and two patients were classified as grade IIIa due to drainage of bile and pleural effusion, including one patient with tachycardia. The mean postoperative hospital stay was 26 days (range: 18-34 days). No patient exhibited decreased cardiac function during surgery or postoperatively, and no patient experienced thoracotomy or phrenic nerve paralysis. CONCLUSIONS Anatomical landmarks are important to ensure a safe approach to the intrapericardial IVC. Incising the pericardium does not lead to serious problems. The transmediastinal, intrapericardial IVC approach for THVE is a feasible method to secure the supra-diaphragmatic intrapericardial IVC.
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Affiliation(s)
- Taiji Tohyama
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
- Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan.
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akihiro Takai
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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