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Meloni MF, Mariani I, Galluzzi P, Pinto S, Filippi E, Romanzi A, Vannelli A. Contrast-enhanced ultrasound (CEUS): one step forward in the identification of "high risk" solitary fibrotic tumors of the liver. J Ultrasound 2024:10.1007/s40477-024-00890-z. [PMID: 38598134 DOI: 10.1007/s40477-024-00890-z] [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: 01/06/2024] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Solitary fibrous tumors of the liver (SFTL) are rare neoplasms, whose identification and definition of malignant potential are challenging. CASE PRESENTATION A 62-year-old patient underwent conventional imaging and CEUS to characterize an indeterminate liver lesion after other imaging techniques were inconclusive. In fact, all diagnostic techniques concluded that it was a partially fibrotic lesion, while CEUS determined its extra-hepatocellular origin and malignant potential, initially hypothesized to be a cholangiocarcinoma. Due to the possible risk of seeding following a biopsy procedure, the patient was a candidate for surgery. Subsequently, histopathological examination revealed SFTL. CONCLUSION CEUS confidently characterized the malignancy and hypothesized the origin of the liver lesion, thus aiding in treatment planning.
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Affiliation(s)
| | - Ilaria Mariani
- Clinica Igea, Milan, Italy.
- Ospedale Manzoni, ASST Lecco, Lecco, Italy.
| | | | - Sabrina Pinto
- Università Degli Studi Di Milano, Scuola Di Specializzazione in Chirurgia Generale, Milan, Italy
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Gatti M, Maino C, Tore D, Carisio A, Darvizeh F, Tricarico E, Inchingolo R, Ippolito D, Faletti R. Benign focal liver lesions: The role of magnetic resonance imaging. World J Hepatol 2022; 14:923-943. [PMID: 35721295 PMCID: PMC9157713 DOI: 10.4254/wjh.v14.i5.923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/07/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
Liver lesions are common findings in radiologists’ daily routine. They are a complex category of pathology that range from solitary benign lesions to primary liver cancer and liver metastases. Benign focal liver lesions can arise from different liver cell types: Epithelial (hepatocytes and biliary cells) and nonepithelial (mesenchymal cells). Liver magnetic resonance imaging (MRI) is a fundamental radiological method in these patients as it allows with its multiparametric approach optimal non-invasive tissue characterization. Furthermore, advanced liver MRI techniques such as diffusion-weighted imaging and hepatobiliary contrast agents have improved the detection of focal liver lesions and can be highly effective in differentiating pseudotumor from tumors, as well as benign from malignant lesions, and can also be used for differential diagnosis. Although histological examination can be useful in making a definitive diagnosis, MRI is an important modality in the diagnosis of liver lesions with a significant impact on patient care. This aim of this review is to provide a comprehensive overview of benign liver lesions on MRI.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Davide Tore
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Andrea Carisio
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Japan
| | | | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, Monza 20900, Italy
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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3
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Delvecchio A, Duda L, Conticchio M, Fiore F, Lafranceschina S, Riccelli U, Cristofano A, Pascazio B, Colagrande A, Resta L, Memeo R. Doege-Potter syndrome by malignant solitary fibrous tumor of the liver: A case report and review of literature. World J Gastrointest Surg 2019; 11:348-357. [PMID: 31523385 PMCID: PMC6715584 DOI: 10.4240/wjgs.v11.i8.348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor of the liver (SFTL) is a rare occurrence with a low number of cases reported in literature. SFTL is usually benign but, 10%-20% cases are reported to be malignant with a tendency to metastasize. The majority of malignant SFTL cases are associated with a paraneoplastic hypoglycaemia defined as Doege-Potter syndrome. Surgery is the best therapeutic treatment, however, long- life follow-up is recommended.
CASE SUMMARY A 74-year-old man, was admitted to the emergency department after a syncopal episode with detection of hypoglycaemia resistant to medical treatment. The computed tomography revealed a solid mass measuring 15 cm of the left liver. An open left hepatectomy was performed with complete resection of tumor. Histopathological analyses confirmed a malignant SFTL.
CONCLUSION Large series with long-term follow-up have not been published neither have clinical trials been undertaken. Consequently, the methodical long-term follow-up of surgically treated SFTLs is strongly recommended.
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Affiliation(s)
- Antonella Delvecchio
- Department of Emergency and Organ Transplantation, General Surgery Unit “M. Rubino”, University of Bari, Bari 70124, Italy
| | - Loren Duda
- Department of Pathology, University of Bari, Bari 70124, Italy
| | - Maria Conticchio
- Department of Emergency and Organ Transplantation, General Surgery Unit “M. Rubino”, University of Bari, Bari 70124, Italy
| | - Felicia Fiore
- Department of Emergency and Organ Transplantation, General Surgery Unit “M. Rubino”, University of Bari, Bari 70124, Italy
| | - Stefano Lafranceschina
- Department of Emergency and Organ Transplantation, General Surgery Unit “M. Rubino”, University of Bari, Bari 70124, Italy
| | - Umberto Riccelli
- Department of Emergency and Organ Transplantation, General Surgery Unit “M. Rubino”, University of Bari, Bari 70124, Italy
| | - Antonella Cristofano
- Department of Oncology, Ente Ecclesiastico Ospedale F. Miulli, Acquaviva delle Fonti 70021, Italy
| | - Bianca Pascazio
- Department of General Surgery, Ospedale San Paolo, Bari 70123, Italy
| | - Anna Colagrande
- Department of Pathology, University of Bari, Bari 70124, Italy
| | - Leonardo Resta
- Department of Pathology, University of Bari, Bari 70124, Italy
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, General Surgery Unit “M. Rubino”, University of Bari, Bari 70124, Italy
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De Los Santos-Aguilar RG, Chávez-Villa M, Contreras AG, García-Herrera JS, Gamboa-Domínguez A, Vargas-Sánchez J, Almeda-Valdes P, Reza-Albarrán AA, Iñiguez-Ariza NM. Successful Multimodal Treatment of an IGF2-Producing Solitary Fibrous Tumor With Acromegaloid Changes and Hypoglycemia. J Endocr Soc 2019; 3:537-543. [PMID: 30788455 PMCID: PMC6371079 DOI: 10.1210/js.2018-00281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022] Open
Abstract
Doege–Potter syndrome with acromegaloid facial changes is extremely rare. Uncooked cornstarch along with glucocorticoids have been used as supportive care in patients with non–islet cell tumor hypoglycemia (NICTH). Preoperative embolization of hepatic solitary fibrous tumors (SFT) with NICTH has yielded unsatisfactory results. Herein we present the case of a 61-year-old man with a 3-month history of severe frequent hypoglycemic episodes and acromegaloid facial changes. During a spontaneous hypoglycemia (26 mg/dL), laboratory values showed a hypoinsulinemic pattern with low levels of GH, IGFPB3, and an IGF2/IGF1 ratio of 8.5:1. Cross-sectional imaging revealed a large (16 × 13 × 11 cm) hepatic tumor, and cytology was consistent with SFT. A preoperative right portal embolization was performed in an effort to induce normal remnant liver hypertrophy to allow for safe tumor resection. After the procedure, uncooked starch treatment followed by prednisone was started, achieving complete remission of hypoglycemic episodes in the preoperative setting. He subsequently underwent partial hepatectomy. The histologic diagnosis was compatible with a potentially malignant SFT. The patient had an excellent outcome with complete remission of hypoglycemia, improvement of facial acromegaloid changes, and no further evidence of disease. To our knowledge, this is the first case of a patient with Doege–Potter syndrome with acromegaloid facial changes induced by a potentially malignant liver SFT, treated successfully with a multimodal approach consisting of uncooked cornstarch, low-dose prednisone, preoperative embolization, and complete surgical resection. The use of cornstarch and low-dose glucocorticoids may be an adequate treatment in advance of undergoing surgery.
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Affiliation(s)
- Ramón G De Los Santos-Aguilar
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mariana Chávez-Villa
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alan G Contreras
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan S García-Herrera
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Armando Gamboa-Domínguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Joel Vargas-Sánchez
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Research Unit for Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo A Reza-Albarrán
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Sun Z, Ding Y, Jiang Y, Zhang Q, Li Z, Xiang J, Duan J, Yan S, Wang W. Ex situ hepatectomy and liver autotransplantation for a treating giant solitary fibrous tumor: A case report. Oncol Lett 2018; 17:1042-1052. [PMID: 30655864 PMCID: PMC6312964 DOI: 10.3892/ol.2018.9693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/17/2018] [Indexed: 12/13/2022] Open
Abstract
A solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Ex situ hepatectomy and liver autotransplantation are novel methods for the treatment of complicated liver tumors, for example, those involving vascular structures, including the inferior vena cava, which are unresectable by conventional approaches. The present study describes a rare case of a massive hepatic SFT in a 32-year-old female who underwent ex situ hepatectomy and liver autotransplantation to achieve a radical resection. The surgery was without complications. Post-operative histopathological and immunohistochemical examinations revealed an SFT of the liver. The patient was discharged 29 days after the surgery with fully recovered liver function. The routine check-up 3 months after surgery indicated normal liver function and no evidence of recurrence. Additionally, an exhaustive review of available literature was performed to provide a complete overview of the current status of SFTs. In summary, the present study found that ex situ hepatectomy and liver autotransplantation are suitable surgical techniques for treating a giant SFT, as well as other liver neoplasms that are considered unresectable by conventional surgery.
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Affiliation(s)
- Zhongquan Sun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
| | - Yuan Ding
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
| | - Yuancong Jiang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
| | - Qiyi Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
| | - Zhiwei Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
| | - Jie Xiang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
| | - Jixuan Duan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
| | - Sheng Yan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
| | - Weilin Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, P.R. China
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Sawka A, Toh D. Biochemical challenge: difficult management of recurrent hypoglycaemia in the setting of a massive solitary fibrous tumour of the liver. Intern Med J 2018; 48:744-746. [DOI: 10.1111/imj.13819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/25/2017] [Accepted: 10/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Alice Sawka
- Department of Thoracic Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Dylan Toh
- Department of Internal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
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Chen N, Slater K. Solitary fibrous tumour of the liver-report on metastasis and local recurrence of a malignant case and review of literature. World J Surg Oncol 2017; 15:27. [PMID: 28100235 PMCID: PMC5242002 DOI: 10.1186/s12957-017-1102-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/12/2017] [Indexed: 02/06/2023] Open
Abstract
Background Solitary fibrous tumours (SFT) are neoplasms of mesenchymal origin that predominantly arise from the pleura. SFT of the liver (SFTL) are a rare occurrence with little number of cases reported in English literature. Malignant cases of hepatic SFT are an even rarer occurrence. For this reason, the prognostic evaluation of SFTLs is unknown and difficult to measure. Methods A search on English literature on “Solitary Fibrous Tumour of the Liver” was conducted on common search engines (PubMed, Google). All published articles, case reports and literature reviews and their reference lists were reviewed. Case report This paper presents a 61-year-old male who was referred to a tertiary hospital in April 2010 with marked hepatomegaly. USS, CT and MRI scans were suggestive of a neoplasm, and the patient underwent a subsegmental IVb resection in June 2010. The specimen demonstrated histological and immunohistochemical features of malignant SFTL with clear resection margins. The patient was followed up regularly for 3 years with imaging and no suggestion of recurrence. Six years after the initial surgery, the patient represented with worsening right upper quadrant pain and dyspnoea secondary to extensive tumour recurrence adjacent to the resection site and metastatic deposits in the pleura. The patient was managed symptomatically and discharged for community follow-up after palliative involvement. Conclusions SFTL are rare with only 84 cases reported in the English Literature including the present case. The average age of patients is 57.1 and occurs in females more than males (1.4:1). Most SFTLs follow a benign course, however, 17.9% of cases displayed malignant histological features. Only three cases including the current case are reported to have both local recurrence and metastasis. Surgical resection remains the mainstay of treatment and appears to be curative of most cases. The rarity of this tumour makes it difficult to evaluate its prognosis and natural course.
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Affiliation(s)
- Nelson Chen
- Department of Hepatobiliary and Pancreatic Surgery, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - Kellee Slater
- Department of Hepatobiliary and Pancreatic Surgery, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
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Beltrán MA. Solitary Fibrous Tumor of the Liver: a Review of the Current Knowledge and Report of a New Case. J Gastrointest Cancer 2016; 46:333-42. [PMID: 26490964 DOI: 10.1007/s12029-015-9769-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Solitary fibrous tumors of the liver (SFTL) are uncommon tumors; to the present day, less than 50 cases has been reported in the English scientific literature, most of which behaved as benign tumors. The present article reports a new case of SFTL and has the main purpose of updating the current knowledge of SFTL because due to its rarity, its clinical presentation, study, treatment, and prognosis are not well known. The clinical presentation, radiologic study, surgical treatment, immunohistochemical study, and prognosis are updated and comprehensively discussed. METHODS Using the common search engines, a search of the English literature was conducted for "Solitary Fibrous Tumor of The Liver," and the relevant articles were retrieved, reviewed, and analyzed. RESULTS All published articles reported anecdotal SFTLs, or SFTLs were included in large series analyzing solitary fibrous tumors on different sites. CONCLUSION The SFTL is an uncommon neoplasm. The clinical presentation is habitually indolent and its behavior is uncertain. In some cases, the SFTL acts as an aggressive sarcoma with poor prognosis. Currently, only surgery offers a therapeutic opportunity for these patients. Due to the lack of current knowledge of long-term behavior of supposedly benign SFTLs and to the lack of specific therapies, methodical long-term follow-up is essential to ensure the survival of patients treated for SFTL.
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