1
|
Narayanan G, Spano A, Gentile NT, Shnayder-Adams MM, Gurusamy V, Levi DM, Wilky BA, Mora RA, Noman R, Peddu P, Dijkstra M. Irreversible Electroporation as a Valid Treatment Option for Hepatic Epithelioid Hemangioendothelioma: An International Multicenter Experience. Cardiovasc Intervent Radiol 2024; 47:883-890. [PMID: 38844684 PMCID: PMC11239779 DOI: 10.1007/s00270-024-03770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Hepatic epithelioid hemangioendothelioma (HEHE) is a rare tumor with currently no established standard of care. This international multicenter retrospective study assesses the use of percutaneous irreversible electroporation (IRE) as an ablative tool to treat HEHE and provides a clinical overview of the current management and role of IRE in HEHE treatment. MATERIAL AND METHODS Between 2017 and 2023, 14 patients with 47 HEHE tumors were treated with percutaneous IRE using CT-scan guidance in 23 procedures. Baseline patient and tumor characteristics were evaluated. Primary outcome measures included safety and effectiveness, analyzed using Common Terminology Criteria for Adverse Events (CTCAE) and treatment response by mRECIST criteria. Secondary outcome measures included technical success, post-treatment tumor sizes and length of hospital stay. Technical success was defined as complete ablation with an adequate ablative margin (intentional tumor free ablation margin > 5 mm). RESULTS IRE treatment resulted in technical success in all tumors. Following a median follow-up of 15 months, 30 tumors demonstrated a complete response according to mRECIST criteria. The average tumor size pre-treatment was 25.8 mm, accompanied by an average reduction in tumor size by 7.5 mm. In 38 out of 47 tumors, there was no evidence of local recurrence. In nine tumors, residual tumor was present. There were no cases of progressive disease. Median length of hospital stay was one day. Only one grade 3 CTCAE event occurred, a pneumothorax requiring chest tube placement. CONCLUSION The current study provides evidence that IRE is a safe and efficacious minimally invasive treatment option for HEHE.
Collapse
Affiliation(s)
- Govindarajan Narayanan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anthony Spano
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Nicole T Gentile
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Michelle M Shnayder-Adams
- Division of Vascular and Interventional Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Varshana Gurusamy
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - David M Levi
- Division of Abdominal Transplant Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA
| | | | - Ronald A Mora
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Raihan Noman
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Praveen Peddu
- Department of Radiology, King's College Hospital NHS Trust, London, UK
| | - Madelon Dijkstra
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Jevdokimova N, Jevdokimov D, Ivanova J, Isajevs S, Staka A, Pukitis A. A Young Female with a Hepatic Epithelioid Hemangioendothelioma. Eur J Case Rep Intern Med 2024; 11:004529. [PMID: 38984174 PMCID: PMC11229466 DOI: 10.12890/2024_004529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 07/11/2024] Open
Abstract
Background Primary hepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare tumour of vascular origin with an incidence of <0.1 cases per 100,000 people worldwide. Case description A 29-year-old female with the history of epigastric pain and unintentional weight loss (3 kg over six months) was referred for upper endoscopy. The examination was without visual pathological findings, but a rapid urease test was positive. First-line treatment with clarithromycin-containing triple therapy for Helicobacter pylori infection was given. After completion of eradication therapy, diffuse abdominal pain developed. An abdominal computed tomography (CT) showed multiple liver nodules. Three consecutive core liver biopsies were performed and were inconclusive. A subsequent surgical liver nodule resection was performed. Histopathology of the specimen revealed grade 2 hepatocellular carcinoma; bone scintigraphy was negative for metastasis. A multidisciplinary team (MDT) recommended giving the patient sorafenib, which was poorly tolerated. The histology was reviewed using immunohistochemistry staining at the request of the oncologist, which showed expression of CD31 and CD34. Based on clinical, morphological and immunohistochemistry findings, a diagnosis of hepatic epithelioid hemangioendothelioma was made. Based on the multidisciplinary team's findings, liver transplantation was indicated as the only curative treatment. Conclusion Because of the rarity of this disease, combining clinical, radiological and histopathological methods as well as an MDT approach can help to reach the correct final diagnosis. As demonstrated in this clinical case, it is crucial to perform immunohistochemistry of a liver biopsy to confirm a HEHE diagnosis. LEARNING POINTS Hepatic epithelioid hemangioendothelioma is a rare vascular tumour that is often misdiagnosed and mismanaged.This case emphasises the critical importance of interdisciplinary teamwork and the use of non-invasive and invasive techniques to achieve a definitive diagnosis.
Collapse
Affiliation(s)
- Natalija Jevdokimova
- Department of Internal Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia
- University of
Latvia, Faculty of Medicine, Riga, Latvia
| | - Denis Jevdokimov
- University of
Latvia, Faculty of Medicine, Riga, Latvia
- Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Jelena Ivanova
- Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Aiga Staka
- University of
Latvia, Faculty of Medicine, Riga, Latvia
- Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Aldis Pukitis
- University of
Latvia, Faculty of Medicine, Riga, Latvia
- Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| |
Collapse
|
3
|
Muscatello LV, Massari F, Roccabianca P, Sarli G, Benazzi C, Bianchi ML. Hepatic Epithelioid Hemangioendothelioma in a Dog. Animals (Basel) 2024; 14:1302. [PMID: 38731306 PMCID: PMC11083527 DOI: 10.3390/ani14091302] [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: 03/25/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
A 5-year-old spayed female Breton dog was referred for a thyroid nodule. A total body CT scan evidenced multifocal hepatic nodules. Cytological liver samples were hemodiluted and non-diagnostic. Following a thyroidectomy, the histology was consistent with a follicular-compact thyroid carcinoma. On laparoscopy, most hepatic lobes had multifocal dark-red nodules that were biopsied for histology. Microscopically, the hepatic parenchyma in the nodules was substituted by blood channels lined by bland spindle cells but adjacent to epithelioid neoplastic cells, single or in clusters, embedded in a moderate amount of edematous collagen matrix. These cells had optically empty cytoplasmic space, occasionally containing erythrocytes (microlumina). Spindle and epithelioid cells expressed membranous-to-cytoplasmic CD31 and FVIII-RA consistent with endothelial origin. Based on morphology and immunolabelling, a hemangioendothelioma with epithelioid differentiation was diagnosed. Lesions in the liver were initially stable, showing progression with time. The dog was alive with no systemic clinical signs 36 months after laparoscopy.
Collapse
Affiliation(s)
- Luisa Vera Muscatello
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (G.S.); (C.B.)
| | - Federico Massari
- DOCVET Clinica Veterinaria Nervianese, Via Rho 2, 20014 Nerviano, Italy; (F.M.); (M.L.B.)
| | - Paola Roccabianca
- Department of Veterinary Medicine, University of Milano, via dell’ Università 6, 26900 Lodi, Italy;
| | - Giuseppe Sarli
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (G.S.); (C.B.)
| | - Cinzia Benazzi
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy; (G.S.); (C.B.)
| | - Marco Luigi Bianchi
- DOCVET Clinica Veterinaria Nervianese, Via Rho 2, 20014 Nerviano, Italy; (F.M.); (M.L.B.)
| |
Collapse
|
4
|
Wang K, Hu J, Wen J, Zhou S, Ye L, Fang C, Guan J, Luo X. A case report of parotid gland epithelioid hemangioendothelioma. Front Surg 2024; 11:1367059. [PMID: 38712336 PMCID: PMC11070531 DOI: 10.3389/fsurg.2024.1367059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare low-grade malignant vascular tumor. It mainly occurs in the liver, lungs, bones, and other parts of the body. Reports of epithelioid hemangioendothelioma in the parotid gland are rare in both domestic and international literature. Here, we present a case report of a parotid gland epithelioid hemangioendothelioma, including its complete clinical course and imaging findings, to improve the diagnosis and treatment of this unusual disease. Case presentation The patient, a 75-year-old female, presented with a swelling around the right ear for 2 months and pain for 20 days. Enhanced MRI of the parotid gland revealed a well-defined, round mass with homogeneous signal intensity. The mass showed low signal intensity on T1-weighted imaging, high signal intensity on T2-weighted imaging, nodular low signal intensity within, significant high signal intensity on DWI sequence, low signal intensity on ADC sequence, and heterogeneous enhancement in the arterial phase after intravenous injection of Gd-DTPA. Nodular non-enhancing low signal intensity was observed internally, and slight clearance was seen in the venous phase. The initial diagnosis before surgery was a benign lesion, but after histopathological and immunohistochemical examination, it was confirmed as epithelioid hemangioendothelioma. Intervention Complete tumor resection was performed. Results The patient experienced a favorable recovery, with meticulous follow-up conducted for up to 1 year revealing no signs of recurrence or metastasis. Continued patient surveillance is ongoing to substantiate and validate the long-term efficacy of the treatment. Conclusion Due to the extreme rarity of parotid gland epithelioid hemangioendothelioma, it often leads to a high misdiagnosis rate. The most common misdiagnosis is salivary gland lymphoma, followed by epithelioid hemangiosarcoma. When the lesion is multifocal, fusiform, with internal necrosis, and shows punctate low signal intensity on T2-weighted imaging, significant enhancement in the arterial phase, particularly with more pronounced peripheral enhancement, and persistent enhancement in the venous and delayed phases, epithelioid hemangioendothelioma should be considered. However, the current clinical diagnosis of epithelioid hemangioendothelioma still primarily relies on immunohistochemical methods.
Collapse
Affiliation(s)
- Ke Wang
- Department of Radiology, The Second People’s Hospital of Quzhou, Quzhou, China
| | - Jianhong Hu
- Department of Radiology, The Second People’s Hospital of Quzhou, Quzhou, China
| | - Jiazhu Wen
- Department of Radiology, The Second People’s Hospital of Quzhou, Quzhou, China
| | - Shuxia Zhou
- Department of Pathology, The Second People’s Hospital of Quzhou, Quzhou, China
| | - Linfeng Ye
- Department of Radiology, The Second People’s Hospital of Quzhou, Quzhou, China
| | - Chun Fang
- Department of Radiology, The Second People’s Hospital of Quzhou, Quzhou, China
| | - Jiacheng Guan
- Department of Radiology, The Second People’s Hospital of Quzhou, Quzhou, China
| | - Xiao Luo
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
5
|
Hu EY, Bhagavatula SK, Shi A, Merriam P, Levesque VM, Shyn PB. Image-guided percutaneous ablation of hepatic epithelioid hemangioendothelioma. Abdom Radiol (NY) 2024; 49:1241-1247. [PMID: 38240859 DOI: 10.1007/s00261-023-04154-y] [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: 10/16/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE Disease control and survival following percutaneous ablation of hepatic epithelioid hemangioendothelioma (EHE) was studied retrospectively. METHODS Six patients underwent 16 image-guided ablation procedures to treat 35 liver tumors from 2015 to 2022 (17 microwave ablation, 9 irreversible electroporation, 8 cryoablation, and 1 radiofrequency ablation). Technical success, local progression, intrahepatic progression, distant progression, overall survival, and adverse events were assessed. RESULTS Four of six (67%) patients were treatment naïve prior to ablation. The mean length of imaging follow-up from first ablation procedure was 43.0 ± 31.2 months. Thirty-three of 35 (94.3%) ablated tumors did not progress locally. Three of 6 patients (50%) had new intrahepatic progression and underwent repeat ablation or systemic treatment. No extrahepatic progression was observed. One patient died from EHE 2.7 years after initial diagnosis. No severe adverse events occurred. CONCLUSION Percutaneous ablation is feasible, often in a staged fashion, and may provide favorable intermediate to long-term disease control for patients with hepatic EHE.
Collapse
Affiliation(s)
- Emmy Y Hu
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharath K Bhagavatula
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Andy Shi
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Priscilla Merriam
- Sarcoma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Vincent M Levesque
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
6
|
Feng L, Li M, Huang Z, Xu M. Hepatic epithelioid hemangioendothelioma-a single-institution experience with 51 cases. Front Oncol 2023; 13:1236134. [PMID: 37601682 PMCID: PMC10435877 DOI: 10.3389/fonc.2023.1236134] [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: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives The aim of the present study was to describe the experience at a single institution in the management of hepatic epithelioid hemangioendothelioma (HEHE). Methods We included 51 patients with histologically confirmed HEHE. We performed log-rank (Cox-Mantel) survival analyses using Kaplan-Meier methods to test differences in survival between patients in different groups. Univariate Cox regression analyses and multivariate proportional hazards regression model were carried out to identify independent prognostic factors. Results Different imaging modalities were used to diagnose HEHE with various presentations. Liver resection (LR), liver transplantation (LT), systemic treatment (ST), and surveillance had been used in our study. A significant difference was noted between the LR group and the surveillance group with respect to mean survival (p = 0.006), as was in the LR group and the ST group (p = 0.036), and in surgical approach (LR and LT) and nonsurgical approach (ST and surveillance) (p = 0.008). The mean survival between the ST group and the surveillance group was not significantly different (p = 0.851). LR (p = 0.010) and surgical approach (p = 0.014) were favorable predictors of outcome, while macrovascular invasion (MaVI) (p = 0.037), lung metastasis (p = 0.040), and surveillance (p = 0.033) were poor prognostic factors in univariate analysis. Multivariate analysis showed that LR (p = 0.010) and surgical approach (p = 0.014) were independently associated with good OS, while surveillance (p = 0.033) was independently associated with poor OS. After adjusting for confounding factors, patients in the LR group have much better OS than those in the surveillance group (p = 0.013). However, there was no significant difference in OS between the LR group and ST group (p = 0.254), as was in the ST group and the surveillance group (p = 0.857). Conclusions The definitive diagnosis of HEHE was dependent on histopathology, and it was not possible to make a specific diagnosis without biopsy because the radiological findings were similar to those in some hepatic malignancies. ST was not recommended for patients who were not candidates for surgical approaches, and surgical approaches should be warranted regardless of disease stage. The retrospective nature and the small size of the data limited the generalizability of the study, designing a worldwide database that contains all data about patients with HEHE independent of their therapy, which was highly recommended.
Collapse
Affiliation(s)
- Lei Feng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Manjie Li
- Radiology Department of West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhuo Huang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingqing Xu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
7
|
Yao Y. 18F-FDG PET/CT findings of hepatic and lung epithelioid hemangioendothelioma. Quant Imaging Med Surg 2023; 13:5443-5446. [PMID: 37581041 PMCID: PMC10423399 DOI: 10.21037/qims-22-1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/15/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Yong Yao
- Department of Nuclear Medicine, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| |
Collapse
|
8
|
Liao X, Lai J, Lin J, Zhang D. Primary and Secondary Angiosarcomas of the Liver: A Multi-institutional Study of 32 Cases. Hum Pathol 2023; 137:10-17. [PMID: 37054784 DOI: 10.1016/j.humpath.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Angiosarcomas involving the liver can be hepatic primary or metastasis from another anatomic site, which have not been systematically compared. We analyzed a series of liver biopsy or resection specimens carrying a diagnosis of angiosarcoma collected between 2005-2018 at 3 tertiary medical centers. The cohort included 32 patients (20 M, 12 F) with a median age of 64 years old. Nineteen were primary hepatic angiosarcoma (PHA) and 13 metastatic to liver (MA). Males were predominant in PHA (15/19, 78%) compared to MA (5/13, 38%, P=0.025). There was no age difference between the two groups. Five cases had background hepatic cirrhosis, which more likely harbored PHA (4/5, 80%). Multifocality and multi-organ involvement were common in both groups. Tumor size was significantly larger in PHA than MA (10.4 vs. 4.7 cm, P<0.01). Histologically, there were no differences in terms of tumor morphology (spindled vs. epithelioid) and growth patterns (vasoformative vs. solid) between the two groups. Immunohistochemically, all tumor cells were positive for CD31 (28/28, 100%) and ERG (18/18, 100%). Molecular analysis in 5 cases demonstrated different mutation profiles involving different genes including MTOR, PIK3CA, ARID1A, CDKN2A, PTEN, TP53, ATRX, KDR/VEGFR2, etc. On follow-up, 30 (93%) patients died of disease at a median survival of 114 days. Univariate and multivariate analysis revealed PHA and epithelioid morphology to be associated with worse survival (P<0.05) while treatment associated with better survival (P<0.001). Our results confirmed that angiosarcoma, particularly PHA is extremely aggressive. Epithelioid morphology is an adverse prognosticator and may be used for tumor subclassification.
Collapse
Affiliation(s)
- Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jinping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| |
Collapse
|
9
|
Tan H, Zhou R, Yu H, Teng F, Si S, Liu L, Yang S, Han D, Liu X. CT appearances and classification of hepatic epithelioid hemangioendothelioma. Insights Imaging 2023; 14:56. [PMID: 37005950 PMCID: PMC10067783 DOI: 10.1186/s13244-023-01410-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (HEH) is extremely rare, and CT features have never been analyzed in a large group of patients. METHODS A retrospective study was designed to review the contrast-enhanced CT images of HEH patients. Intrahepatic lesions were categorized into three types: nodular, locally coalescent (coalescent lesion contained in one segment) or diffusely coalescent (coalescent lesion occupied more than one segment). CT features were compared among lesions of different sizes and patients with different lesion types. RESULTS A total of 93 HEH patients were included in this study, and 740 lesions were analyzed. The results of per-lesion analysis showed that medium lesions (2-5 cm) had the highest rate of lollipop sign (16.8%) and target-like enhancement (43.1%), while lesions in large group (> 5 cm) had the highest rate of capsular retraction (38.8%) and vascular invasion (38.8%). The differences on enhancement pattern and the rates of lollipop sign and capsular retraction were significant among lesions of different sizes (p < 0.001, respectively). The results of per-patient analysis showed that patients in locally coalescent group had the highest rates of lollipop sign (74.3%) and target sign (94.3%). All patients in diffusely coalescent group had capsular retraction and vascular invasion. CT appearances of capsular retraction, lollipop sign, target sign and vascular invasion differed significantly among patients with different lesion types (p < 0.001, p = 0.005, p = 0.006 and p < 0.001, respectively). CONCLUSION CT features variated among HEH patients with different lesion types, and radiological appearances of HEH should be classified into nodular type, locally coalescent type and diffusely coalescent type.
Collapse
Affiliation(s)
- Haidong Tan
- Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Ruiquan Zhou
- Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Hongwei Yu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Feng Teng
- Department of Radiation Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Shuang Si
- Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Liguo Liu
- Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Shiwei Yang
- Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Dongdong Han
- Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Xiaolei Liu
- Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China.
| |
Collapse
|
10
|
Zeng H, Tang X, Tian X, Liu Y, Tian P. Poor response to sintilimab plus chemotherapy in a pulmonary epithelioid hemangioendothelioma patient: a case report. Immunotherapy 2023; 15:77-83. [PMID: 36695105 DOI: 10.2217/imt-2022-0073] [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: 01/26/2023] Open
Abstract
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular tumor with no established treatment protocol. The authors report the case of a young woman diagnosed with PEH. DNA and RNA analysis by next-generation sequencing was performed on the tumor tissue. A novel germline PALB2 mutation and classical WWTR1-CAMTA1 fusion were identified. She experienced a poor response to sintilimab (a PD-1 inhibitor) plus platinum-based chemotherapy as the first-line treatment. PEH patients harboring a germline PALB2 mutation and WWTR1-CAMTA1 gene fusion may respond poorly to treatment with PD-1 inhibitors plus chemotherapy.
Collapse
Affiliation(s)
- Hao Zeng
- Department of Respiratory & Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaojun Tang
- Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xia Tian
- Department of Respiratory & Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yujie Liu
- Department of Respiratory & Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Panwen Tian
- Department of Respiratory & Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| |
Collapse
|
11
|
Ajay PS, Tsagkalidis V, Casabianca A, Burchard PR, Melucci AD, Chacon A, Goyal S, Switchenko JM, Kooby DA, Carpizo DR, Shah MM. A review of hepatic epithelioid hemangioendothelioma-Analyzing patient characteristics and treatment strategies. J Surg Oncol 2022; 126:1423-1429. [PMID: 35975699 PMCID: PMC9836828 DOI: 10.1002/jso.27066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (HEH) is a rare vascular tumor of unknown etiology and unpredictable natural history. To date, no large-scale studies have been published evaluating this disease due to its rare occurrence. METHODS The National Cancer Database was reviewed between 2004 and 2016 to identify patients with HEH. Univariate analysis with overall survival (OS) was performed by Cox proportional hazards model. Kaplan-Meier method was used to create OS curves and compared using the log-rank test. RESULTS We identified 229 patients with HEH. The majority of patients were female (61.1%), white (84.3%), and had a Charlson-Deyo score of 0 (75%). Chemotherapeutic intervention was seen in 26% of the patients while 33% received surgical intervention in the form of wedge/segmental liver resection (n = 27), hepatectomy lobectomy/extended lobectomy (n = 18), and liver transplant (n = 22). Five-year survival in surgical patients was 90.5%, 66.5% and 81%, respectively (p = 0.485). Age greater than 55 years (hazard ratio [HR], 2.78; p < 0.001), Asian ethnicity compared to white (HR, 2.84; p = 0.012), and a higher Charlson-Deyo score (score 1: HR, 2.28; p < 0.001 and score ≥2: HR, 2.76; p = 0.011) were associated with worse OS. CONCLUSION Treatment for HEH remains variable with only a third of the patients undergoing surgery. International collaboration is necessary to determine the optimal treatment for this rare disease.
Collapse
Affiliation(s)
- Pranay S. Ajay
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasileios Tsagkalidis
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Anthony Casabianca
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R. Burchard
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alexa D. Melucci
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alexander Chacon
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - David A. Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Darren R. Carpizo
- Division of Surgical Oncology, Wilmot Caner Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Mihir M. Shah
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
12
|
Interventional Management of Portal Hypertension in Cancer Patients. Curr Oncol Rep 2022; 24:1461-1475. [PMID: 35953600 DOI: 10.1007/s11912-022-01319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the classifications and clinical hallmarks of common cancer-related conditions that contribute to the high incidence of portal hypertension in this population and provide an update on currently available interventional radiology therapeutic approaches. RECENT FINDINGS In the last few decades, there have been significant advancements in understanding the pathophysiology of portal hypertension. This knowledge has led to the development of safer and more effective minimally invasive approaches. The main objective is to provide alternatives to prevent life-threatening complications from clinically significant portal hypertension and to allow the continuation of cancer treatment interventions that would otherwise be stopped. Clinicians involved in cancer care should be aware of risk factors, associated complications, and management of portal hypertension in cancer patients. Interventional radiology offers minimally invasive alternatives that play a central role in improving clinical outcomes and survival of these patients, allowing the continuation of cancer treatments.
Collapse
|
13
|
Chu K, Li Z, Tang W, Jiang X. Updated information regarding management of hepatic epithelioid hemangioendothelioma. Intractable Rare Dis Res 2022; 11:211-214. [PMID: 36457586 PMCID: PMC9709622 DOI: 10.5582/irdr.2022.01113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/10/2022] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare hepatic vascular tumor with a borderline biological behavior between hemangioma and hemangiosarcoma. It tends to be multiple or diffuse subcapsular lesions across the liver but has no characteristic clinical manifestations or imaging findings. On computed tomography and magnetic resonance imaging, these lesions usually have a hypodense appearance with heterogeneous enhancement and a "halo sign" or "lollipop sign" may be evident in some cases. HEHE is diagnosed mainly based on a pathological examination along with differential immunohistochemical markers such as CAMTA1, CD31, CD34, CD10, vimentin, and factor VIII antigen. Currently, there are no standardized treatment guidelines for HEHE, and surgery (curative resection and liver transplantation) remains the mainstay of treatment. Studies have indicated that extra-hepatic metastasis might not be a contraindication for resection or transplantation. Systemic chemotherapeutic agents including doxorubicin, vincristine, interferon-a, 5-fluorouracil, and thalidomide, as well as VEGF-related agents are being investigated, but no agents have been approved for the treatment of HEHE.
Collapse
Affiliation(s)
- Kaijian Chu
- Biliary Surgery Department No. 1, Eastern Hepatobiliary Surgical Hospital, Naval Medical University, Shanghai, China
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Zhizheng Li
- Biliary Surgery Department No. 1, Eastern Hepatobiliary Surgical Hospital, Naval Medical University, Shanghai, China
| | - Wei Tang
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- International Health Care Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Xiaoqing Jiang
- Biliary Surgery Department No. 1, Eastern Hepatobiliary Surgical Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
14
|
Fang J, Ji Y, Zhao W, Pu C, Mi S, Zhang B. Three cases of hepatic epithelioid hemangioendothelioma evaluated using conventional and contrast-enhanced ultrasound: Case reports. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:826-831. [PMID: 35018654 PMCID: PMC9540860 DOI: 10.1002/jcu.23141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a very rare vascular endothelial cell tumor, which lacks typical clinical manifestations and specificity of imaging features. Whether the background of fatty liver and the difference in Contrast enhanced ultrasound (CEUS) characteristics between large and small lesions has not been well defined. In this case reports, we described the ultrasound image features of three patients with HEHE. These three patients with HEHE have certain similar characteristics of conventional ultrasound and CEUS. CEUS imaging features include large nodules show earlier perfusion than liver parenchyma, with rim-enhancement, nonenhancing regions in the center, while small nodules show earlier perfusion than liver parenchyma, with hyperenhancement. All nodules show faster washout than hepatic parenchyma, showing heterogeneous hypoenhancement, and more washout lesions can be found in the PVP and LP. Conventional ultrasound and CEUS not only help to improve the diagnostic confidence of HEHE of rare liver tumors, but also can guide the biopsy area, making it easier to make accurate pathological diagnosis.
Collapse
Affiliation(s)
- Jian‐Qiang Fang
- Department of Interventional UltrasoundXianyang Central HospitalXianyangChina
| | - Ya‐Yun Ji
- Department of Interventional UltrasoundXianyang Central HospitalXianyangChina
| | - Wei‐An Zhao
- Department of Interventional UltrasoundXianyang Central HospitalXianyangChina
| | - Cui Pu
- Department of Interventional UltrasoundXianyang Central HospitalXianyangChina
| | - Si‐Yuan Mi
- Department of Interventional UltrasoundXianyang Central HospitalXianyangChina
| | - Bin‐Yu Zhang
- Department of Interventional UltrasoundXianyang Central HospitalXianyangChina
| |
Collapse
|
15
|
Mo WF, Tong YL. Hepatic epithelioid hemangioendothelioma after thirteen years’ follow-up: A case report and review of literature. World J Clin Cases 2022; 10:6119-6127. [PMID: 35949854 PMCID: PMC9254202 DOI: 10.12998/wjcc.v10.i18.6119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/24/2022] [Accepted: 04/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (EHE) is a rare vascular endothelial cell tumor of the liver, consisting of epithelioid and histiocyte-like vascular endothelial cells in mucus or a fibrotic matrix. Immunohistochemistry is usually positive for vascular markers, such as factor VIII-related antigen, CD31, and CD34. Hepatic EHE can have a varied clinical course; treatment includes liver transplantation, liver resection, chemotherapy, and radiation therapy.
CASE SUMMARY A 46-year-old woman with abdominal discomfort and elevated serum carcinoembryonic antigen was found to have multiple low-density lesions in the liver and lung on computed tomography (CT) evaluation. An ultrasound-guided fine needle aspiration biopsy revealed a fibrous stroma with dendritic cells, containing intracellular vacuoles. Immunohistochemical staining found that the tumor cells were positive for CD34, CD31, and factor VIII-related antigen. The patient received four courses of combined chemotherapy and was followed-up for 13 years, at which time the patient was in stable condition without disease progression and a confined neoplasm, as evidenced by CT scans.
CONCLUSION The histology and immunohistochemical characteristics of hepatic EHE are well described. Chemotherapy may be effective in patients with extrahepatic lesions.
Collapse
Affiliation(s)
- Wei-Fang Mo
- Department of General Practice, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, Zhejiang Province,China
| | - Yu-Ling Tong
- Department of General Practice, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, Zhejiang Province,China
| |
Collapse
|
16
|
Bisbee CA, Burstiner L, Natcheva H. Hepatic Epithelioid Hemangioendothelioma With Unique Metastasis to the Superior Vena Cava Found on CT Imaging: A Case Study. Cureus 2022; 14:e26155. [PMID: 35891869 PMCID: PMC9302553 DOI: 10.7759/cureus.26155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/09/2022] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare malignant tumor of vascular origin. Classically, HEHE is typically associated with imaging demonstrating multifocal heterogeneously enhancing hepatic nodules and histologic examination revealing mixed epithelioid and dendritic cells in a proliferative fibrous stromal background. While generally described as a low-to-intermediate grade indolent tumor, it is essential to establish the presence or absence of extrahepatic spread when considering transplant candidacy. We describe one case study in which a transplant was denied to a unique metastatic pattern of HEHE to the superior vena cava. This is a previously unreported location of metastasis of HEHE and may serve to broaden our current understanding of potential metastatic sites for this disease.
Collapse
|
17
|
Zhao M, Yin F. Hepatic epithelioid hemangioendothelioma: Clinical characteristics, diagnosis, treatment, and prognosis. World J Clin Cases 2022; 10:5606-5619. [PMID: 35979122 PMCID: PMC9258370 DOI: 10.12998/wjcc.v10.i17.5606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/23/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (HEHE) is a rare hepatic vascular tumor with unpredictable malignant potential. The etiology, characteristics, diagnosis, treatment, and prognosis of HEHE are not well-understood, and large-scale retrospective studies are required to understand better this disease.
AIM To determine the characteristics of HEHE and identify its optimal treatments and prognostic factors.
METHODS The clinical data of two patients diagnosed with HEHE at the Fourth Hospital of Hebei Medical University and 258 previously reported cases retrieved from the China National Knowledge Infrastructure and PubMed databases between 1996 and 2021 were combined and summarized. All cases were pathologically identified as HEHE. Information such as clinical features, laboratory examination findings, imaging findings, pathological characteristics, treatment, and survival periods was reviewed. Kaplan-Meir curves were used for survival analysis. Prognostic factors were identified by Cox regression analysis.
RESULTS HEHE primarily affected middle-aged women. The typical manifestations included epigastric pain, hepatosplenomegaly, inappetence, distension, weight loss, and fatigue. Tumor markers were expressed normally. The incidence of extrahepatic metastasis was 34.5% at the time of diagnosis. The most common sites of extrahepatic involvement were the lungs (22.3%), lymph nodes (5.6%), peritoneum (3.6%), bones (6.6%), and spleen (5.1%). Furthermore, “capsular retraction”, “target sign”, and “lollipop sign” were the characteristic features of HEHE on imaging. The immunohistochemical profile for HEHE (expression of vascular markers, such as factor VIII-related antigen, CD31, and CD34; expression levels of D2-40) can facilitate and ensure an accurate diagnosis. The management options for patients with HEHE include liver resection (29.7%), liver transplantation (16.1%), palliative treatments (12.7%), transhepatic arterial chemotherapy and embolization (TACE, 10.2%), chemotherapy (11.0%), antiangiogenic therapy (15.3%), and other treatments (5.1%); the mean survival time was 158.6, 147.3, 4.2, 90.8, 71.4, 83.1, and 55.0 mo, respectively. The survival time of patients who underwent surgical treatment was longer than that of patients who did not. TACE and antiangiogenic therapy tended to prolong survival compared with other nonsurgical treatments. The 1-, 5-, and 10-year survival rates were 82%, 71%, and 64%, respectively. Multivariate analysis showed that liver function (P = 0.045), intrahepatic metastasis (P = 0.029), and treatment (P = 0.045) were independent prognostic factors. The presence of extrahepatic metastases was not an independent risk factor for poor prognosis (P = 0.558).
CONCLUSION The clinical course of HEHE is rare and variable, and patients with intrahepatic metastases and liver dysfunction may have a poorer prognosis than those without. Surgical intervention, whether liver resection or transplantation, might be warranted regardless of extrahepatic metastasis. For patients without the option for surgery, clinicians should consider the use of TACE with antiangiogenic drugs in the treatment of HEHE.
Collapse
Affiliation(s)
- Man Zhao
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Fei Yin
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| |
Collapse
|
18
|
Kolleri JJ, Khaliq A, Ladumor SB, Habtezghi AB, Koshy SM, Petkar M. Primary Hepatic Epithelioid Hemangioendothelioma Masquerading as a Hepatic Abscess With Infective Picture: A Case Report. Cureus 2022; 14:e22859. [PMID: 35392441 PMCID: PMC8977811 DOI: 10.7759/cureus.22859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/09/2022] Open
Abstract
Hepatic endotheiloid hemangioendothelioma (EHE) commonly presents with multilobar involvement with locally aggressive behavior. In most cases, it presents with right upper quadrant abdominal pain, hepatomegaly, and weight loss with metastasis commonly to the lung. We present a 33-year-old woman with hepatic EHE with an initial presentation mimicking hepatic abscess and imaging findings misleading for metastatic liver lesions. It was confirmed on pathology with immunohistochemistry, but the patient could not survive due to her late presentation and the presence of metastatic lesions in the lung.
Collapse
|
19
|
Wang X, Liang P, Lv P, Li R, Hou P, Gao J. Clinical characteristics and CT features of hepatic epithelioid haemangioendothelioma and comparison with those of liver metastases. Insights Imaging 2022; 13:9. [PMID: 35050424 PMCID: PMC8776937 DOI: 10.1186/s13244-021-01143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyse clinical characteristics and computer tomography (CT) findings of hepatic epithelioid haemangioendothelioma (HEH) and to determine differential features compared with liver metastasis (LM). METHODS This retrospective study included 80 patients with histopathologically confirmed HEH (n = 20) and LM (n = 60) of different primary tumours who underwent dynamic contrast-enhanced CT scans. CT findings included the location, contour, size, number, margin, and density of lesions, the patterns and degree of contrast enhancement of lesions, vascular invasion and changes in other organs. The enhancement ratio (ER) and tumour-to-normal parenchyma ratio (TNR) were calculated. Receiver operating characteristic curves (ROCs) were used to determine areas under the curve (AUCs). RESULTS About 65% of HEH lesions were located in submarginal areas. Significant differences were observed between HEH and LM patients in age, sex, and tumour marker positivity (p < 0.05). HEH showed minimal to slight enhancement, thin ring-like enhancement in arterial phase, and slight, homogeneous, progressive enhancement in the portal phase. HEH presented capsule retraction, and the "target" sign and the "lollipop" sign were significantly more frequent than in LM (p < 0.05). The ER and TNR in the arterial phase of HEH were lower than those of LM (p < 0.05). AUCs of ER and TNR in the arterial phase were 0.74 and 0.73, respectively. CONCLUSION Lesions in subcapsular locations, capsular retraction, slight and thin ring-like enhancement, "target" and "lollipop" signs and lower ER and TNR in the arterial phase may represent important features of HEH compared with LM.
Collapse
Affiliation(s)
- Xiaopeng Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan Province, China
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan Province, China
| | - Peijie Lv
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan Province, China
| | - Rui Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan Province, China
| | - Ping Hou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan Province, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan Province, China.
| |
Collapse
|
20
|
Serji B, Ramdani A, Mirali H, Bouhout T, Bennani A, El Harroudi T. Hepatic epithelioid hemangioendothelioma simulating liver metastasis: A case report. Ann Med Surg (Lond) 2021; 70:102885. [PMID: 34691426 PMCID: PMC8519773 DOI: 10.1016/j.amsu.2021.102885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Hepatic epithelioid hemangioendothelioma (HEHE) is a rare tumor of vascular origin. Liver involvement is often multinodular simulating metastases. Herein, we report a rare case of HEHE mimicking liver metastases in a female patient. Case presentation A 43-years-old female patient, presented with complaints of pain in the right upper quadrant. Laboratory tests were all within the normal range. Abdominal ultrasound revealed multiple heterogeneous hypoechoic liver lesions. A thoracic and abdominopelvic computed tomography showed bilateral pulmonary micronodules with multiple hypodense hepatic nodules involving both lobes. Percutaneous ultrasound-guided biopsy with pathological study and immunohistochemistry staining revealed the diagnosis of hepatic epithelioid hemangioendothelioma. Discussion HEHE usually involves both liver lobes with three radiological presentations: single nodular, multiple nodular, or diffuse types, the diffuse type reflects an advanced stage. 3/4 of the cases are initially misdiagnosed as liver metastases or primary liver tumors. The pathological study with the immunochemistry stainings confirms the diagnosis. There is no standard treatment for HEHE due to its rarity and lack of prospective randomized studies. Conclusion HEHE is a rare tumor of vascular origin of unknown etiology with malignant potential and unpredictable course. The therapeutic management of this rare condition is not codified and is discussed on a case-by-case basis. Surgical treatment remains the best option with an excellent outcome. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin. The Clinical presentation and the radiological findings are not specific. Final Diagnosis is made upon pathological study and immunohistochemistry staining. Surgical treatment remain the treatment of choice.
Collapse
Affiliation(s)
- Badr Serji
- Surgical Oncology Department, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Abdelbassir Ramdani
- Surgical Oncology Department, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Houda Mirali
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco.,Radiology Department, Mohammed VI University Hospital, Oujda, Morocco
| | - Tariq Bouhout
- Surgical Oncology Department, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Amal Bennani
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco.,Pathology Department, Mohammed VI University Hospital, Oujda, Morocco
| | - Tijani El Harroudi
- Surgical Oncology Department, Mohammed VI University Hospital, Regional Oncology Center, Oujda, Morocco.,Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| |
Collapse
|
21
|
Johnson L, Ford R, Johnson PA. Hepatic Epithelioid Hemangioendothelioma Discovered Incidentally on Computerized Tomography. Kans J Med 2021; 14:259-260. [PMID: 34671443 PMCID: PMC8523111 DOI: 10.17161/kjm.vol14.15326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Luke Johnson
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Ryan Ford
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Paul A Johnson
- University of Kansas School of Medicine-Salina, Salina, KS
| |
Collapse
|
22
|
Stacchiotti S, Miah AB, Frezza AM, Messiou C, Morosi C, Caraceni A, Antonescu CR, Bajpai J, Baldini E, Bauer S, Biagini R, Bielack S, Blay JY, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brodowicz T, Callegaro D, De Alava E, Deoras-Sutliff M, Dufresne A, Eriksson M, Errani C, Fedenko A, Ferraresi V, Ferrari A, Fletcher CDM, Garcia Del Muro X, Gelderblom H, Gladdy RA, Gouin F, Grignani G, Gutkovich J, Haas R, Hindi N, Hohenberger P, Huang P, Joensuu H, Jones RL, Jungels C, Kasper B, Kawai A, Le Cesne A, Le Grange F, Leithner A, Leonard H, Lopez Pousa A, Martin Broto J, Merimsky O, Merriam P, Miceli R, Mir O, Molinari M, Montemurro M, Oldani G, Palmerini E, Pantaleo MA, Patel S, Piperno-Neumann S, Raut CP, Ravi V, Razak ARA, Reichardt P, Rubin BP, Rutkowski P, Safwat AA, Sangalli C, Sapisochin G, Sbaraglia M, Scheipl S, Schöffski P, Strauss D, Strauss SJ, Sundby Hall K, Tap WD, Trama A, Tweddle A, van der Graaf WTA, Van De Sande MAJ, Van Houdt W, van Oortmerssen G, Wagner AJ, Wartenberg M, Wood J, Zaffaroni N, Zimmermann C, Casali PG, Dei Tos AP, Gronchi A. Epithelioid hemangioendothelioma, an ultra-rare cancer: a consensus paper from the community of experts. ESMO Open 2021; 6:100170. [PMID: 34090171 PMCID: PMC8182432 DOI: 10.1016/j.esmoop.2021.100170] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is an ultra-rare, translocated, vascular sarcoma. EHE clinical behavior is variable, ranging from that of a low-grade malignancy to that of a high-grade sarcoma and it is marked by a high propensity for systemic involvement. No active systemic agents are currently approved specifically for EHE, which is typically refractory to the antitumor drugs used in sarcomas. The degree of uncertainty in selecting the most appropriate therapy for EHE patients and the lack of guidelines on the clinical management of the disease make the adoption of new treatments inconsistent across the world, resulting in suboptimal outcomes for many EHE patients. To address the shortcoming, a global consensus meeting was organized in December 2020 under the umbrella of the European Society for Medical Oncology (ESMO) involving >80 experts from several disciplines from Europe, North America and Asia, together with a patient representative from the EHE Group, a global, disease-specific patient advocacy group, and Sarcoma Patient EuroNet (SPAEN). The meeting was aimed at defining, by consensus, evidence-based best practices for the optimal approach to primary and metastatic EHE. The consensus achieved during that meeting is the subject of the present publication. This consensus paper provides key recommendations on the management of epithelioid hemangioendothelioma (EHE). Recommendations followed a consensus meeting between experts and a representative of the EHE advocacy group and SPAEN. Authorship includes a multidisciplinary group of experts from different institutions from Europe, North America and Asia.
Collapse
Affiliation(s)
- S Stacchiotti
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - A B Miah
- The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - A M Frezza
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Messiou
- Department of Radiology, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - C Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - J Bajpai
- Medical Oncology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - E Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Center/Brigham and Women's Hospital, Boston, USA
| | - S Bauer
- Department of Medical Oncology, West German Cancer Center, Sarcoma Center, University of Duisburg-Essen, University Hospital, Essen, Germany
| | - R Biagini
- Orthopaedic Department, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart - Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Pädiatrische Onkologie, Hämatologie, Immunologie, Stuttgart, Germany
| | - J Y Blay
- Department of Medical Oncology, Centre Leon Berard, Université Claude Bernard Lyon, Unicancer, Lyon, France
| | - S Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - T Brodowicz
- Medical University Vienna & General Hospital Department of Internal Medicine 1/Oncology, Vienna, Austria
| | - D Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E De Alava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | | | - A Dufresne
- Department of Medical Oncology, Centre Leon Berard, Université Claude Bernard Lyon, Unicancer, Lyon, France
| | - M Eriksson
- Department of Oncology, Skane University Hospital and Lund University, Lund, Sweden
| | - C Errani
- Orthopaedic Service, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Fedenko
- Medical Oncology Division, P.A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C D M Fletcher
- Department of Pathology Brigham & Women's Hospital, Boston, USA
| | - X Garcia Del Muro
- University of Barcelona and Genitourinary Cancer and Sarcoma Unit Institut Català d'Oncologia, Hospitalet, Barcelona, Spain
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A Gladdy
- University of Toronto and Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - F Gouin
- Department of Surgery, Centre Leon Berard, Lyon, France
| | - G Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - J Gutkovich
- The EHE Foundation, Wisconsin, USA; NUY Langone Medical Center, New York, USA
| | - R Haas
- Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiotherapy, the Leiden University Medical Center, Leiden, the Netherlands
| | - N Hindi
- Group of Advanced Therapies and Biomarkers in Sarcoma, Institute of Biomedicine of Seville (IBIS, HUVR, CSIC, Universidad de Sevilla), Seville, Spain
| | - P Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Heidelberg, Germany
| | - P Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - H Joensuu
- Department of Oncology, Helsinki University Hospital & Helsinki University, Helsinki, Finland
| | - R L Jones
- Department of Cancer, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - C Jungels
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - B Kasper
- University of Heidelberg, Mannheim University Medical Center, Sarcoma Unit, Mannheim, Germany
| | - A Kawai
- Musculoskeletal Oncology and Rehabilitation Medicine, Rare Cancer Center National Cancer Center Hospital, Tokyo, Japan
| | - A Le Cesne
- International Department, Gustave Roussy, Villejuif, France
| | - F Le Grange
- UCLH - University College London Hospitals NHS Foundation Trust, London, UK
| | - A Leithner
- Department of Orthopaedics and Trauma Medical University Graz, Graz, Austria
| | - H Leonard
- Chair of Trustees of the EHE Rare Cancer Charity (UK), Charity number 1162472
| | - A Lopez Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin Broto
- Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
| | - O Merimsky
- Unit of Soft Tissue and Bone Oncology, Division of Oncology, Tel-Aviv Medical Center affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Merriam
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - R Miceli
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - O Mir
- Sarcoma Group, Gustave Roussy, Villejuif, France
| | - M Molinari
- University of Pittsburgh Medical Center, Thomas Starzl Transplant Institute, Pittsburgh, USA
| | | | - G Oldani
- Division of Abdominal Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - E Palmerini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - S Patel
- Sarcoma Center, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | | | - C P Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, USA; Center for Sarcoma and Bone Oncology, Harvard Medical School, Boston, USA; Dana Farber Cancer Center, Harvard Medical School, Boston, USA
| | - V Ravi
- Sarcoma Center, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - A R A Razak
- Princess Margaret Cancer Centre and Sinai Healthcare System & Faculty of Medicine, University of Toronto, Toronto, Canada
| | - P Reichardt
- Helios Klinikum Berlin-Buch, Department of Oncology and Palliative Care, Berlin, Germany
| | - B P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, USA
| | - P Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - G Sapisochin
- Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedaliera Università Padova, Padua, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | | | - D Strauss
- Department of Surgery, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - S J Strauss
- University College London Hospital, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - W D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Tweddle
- Palliative Care, The Royal Marsden Hospital and The Institute of Cancer Research London
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M A J Van De Sande
- Department of Orthopedic Surgery Bone and Soft Tissue Tumor Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - W Van Houdt
- Sarcoma and Melanoma Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G van Oortmerssen
- Co-Chair of Sarcoma Patients EuroNet (SPAEN), Woelfersheim, Germany & Chairman of the Dutch organisation for sarcoma patients (Patiëntenplatform Sarcomen), Guest researcher at Leiden University (Leiden Institute for Advanced Computer Science), Leiden University, Leiden, The Netherlands
| | - A J Wagner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Wartenberg
- Chair of the Board of Directors of Sarcoma Patients EuroNet (SPAEN), Sarcoma Patients EuroNet (SPAEN), Woelfersheim, Germany
| | - J Wood
- The Royal Marsden NHS Foundation Trust, London, UK
| | - N Zaffaroni
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre and Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - P G Casali
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedaliera Università Padova, Padua, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|