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Park SB, Kim YB, You S. Epithelioid hemangioendothelioma: a case report. AME Case Rep 2024; 8:65. [PMID: 39091552 PMCID: PMC11292091 DOI: 10.21037/acr-23-51] [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: 04/24/2023] [Accepted: 04/11/2024] [Indexed: 08/04/2024]
Abstract
Background Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with limited clinical data that can guide treatment choices. The diagnosis of EHE is based on its unique histological, immunohistochemical, and molecular characteristics. Differential diagnoses are broad and include autoimmune diseases. Treatments include hepatic resection, liver transplantation, systemic/regional chemotherapy, and radiotherapy. Case Description We describe EHE in a patient with weight loss and general weakness. The prognosis of EHE is variable, with few cases demonstrating an indolent clinical course, whereas others tend to metastasize. In our case, hepatic EHE had metastasized to the lungs and brain. Histopathological examination of the liver tissue revealed an epithelial hemangioendothelioma. On CK7 staining, hepatocytes were clearly reactive and arranged in the plates (CK7: negative), with positive immunohistochemical staining for CD34 (CD34: positive) alone. Surveillance was conducted and the clinical course was better than expected, probably due to her relatively good general condition, the lack of genetic factors associated with her familial medical history, and normal levels of tumor markers such as α-fetoprotein and carcinoembryonic antigen (CEA). During a follow-up examination, she was asymptomatic with a healthy general appearance. Conclusions The prognosis of EHE is variable, with few cases demonstrating an indolent clinical course, whereas others tend to metastasize. The treatment method for EHE should be determined according to the patient's condition.
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Affiliation(s)
- Sat Byul Park
- Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, Korea
| | - Young Bae Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Seulgi You
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
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Tang W, Niu Y, Luo Y, Ma X. Characteristic contrast‑enhanced ultrasound findings of hepatic epithelioid haemangioendothelioma: A case report and literature review. Oncol Lett 2023; 25:253. [PMID: 37205916 PMCID: PMC10189842 DOI: 10.3892/ol.2023.13839] [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: 11/24/2022] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare liver tumor, which is usually diagnosed by pathological examination, since the diagnostic imaging criteria remain to be defined. However, contrast-enhanced ultrasound (CEUS) may reveal the characteristic features of HEHE to aid diagnosis. In the present study, two-dimensional ultrasound examination of a 38-year-old male patient showed a mass in the right liver. CEUS showed an S5 segment hypoechoic nodule, and imaging features resulted in the diagnosis of HEHE. Surgery was shown to be an appropriate and successful treatment for HEHE. In conclusion, CEUS may be valuable for the diagnosis of HEHE, thereby avoiding the serious consequences of misdiagnosis.
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Affiliation(s)
- Wen Tang
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Yifan Niu
- Department of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Yang Luo
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Xiaojuan Ma
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, Sichuan 610000, P.R. China
- Correspondence to: Dr Xiaojuan Ma, Department of Ultrasound, Chengdu First People's Hospital, 18 Wanxiang South Road, Hightech Zone, Chengdu, Sichuan 610000, P.R. China, E-mail:
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Luo L, Cai Z, Zeng S, Wang L, Kang Z, Yang N, Zhang Y. CT and MRI features of hepatic epithelioid haemangioendothelioma: a multi-institutional retrospective analysis of 15 cases and a literature review. Insights Imaging 2023; 14:2. [PMID: 36600110 DOI: 10.1186/s13244-022-01344-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To improve the current imaging understanding of MRI or CT for hepatic epithelioid haemangioendothelioma (HEHE) to aid in its successful preoperative diagnosis. METHODS The imaging features of 15 patients (median age 38.6, range 20-71; 7 M/8 F) from eight institutions with pathologically confirmed HEHE were retrospectively analysed. Additionally, the CT/MR imaging features of 180 patients in 15 literature publications were collected, analysed and compared with our case series. RESULTS Fifteen patients underwent CT and MRI (n = 2), CT (n = 9) or MR (n = 8) scans. A total of 92.9% (13/14) of the patients were initially diagnosed with other lesions on imaging. A total of 86.7% (13/15) were multifocal. Nodules (11/15, 73.3%) were predominantly peripheral in distribution (12/15, 80.0%). Some cases were associated with hepatic capsular retraction (13/15, 86.7%), "target signs" (8/15, 53.3%) and "lollipop signs" (5/15, 33.3%). Peripheral enhancement of various shapes in the early phase with a progressive centripetal filling was the most common pattern of enhancement (12/15, 80.0%). Abnormal vascularity was seen in 50.7% (6/15) of the patients. Suspicious tumour thromboses in the inferior vena cava were seen in 3 (20.0%) of the patients. Two of the 15 patients (13.3%) had a history of smoking. CONCLUSIONS HEHEs have common distinctive features, including multifocal lesions that are predominantly peripheral, "target signs", "lollipop signs", hepatic capsular retraction and peripheral enhancement of various shapes in the early phase with progressive centripetal filling. Additional aggressive imaging features that may be valuable clues to the diagnosis can be identified by CT or MRI.
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Affiliation(s)
- Lianmei Luo
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua Dong Road, Zhuhai, 519000, Guangdong, China
| | - Zeyu Cai
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua Dong Road, Zhuhai, 519000, Guangdong, China
| | - Sihui Zeng
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lizhu Wang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua Dong Road, Zhuhai, 519000, Guangdong, China
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ning Yang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Yaqin Zhang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua Dong Road, Zhuhai, 519000, Guangdong, China.
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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.
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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
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Huda T, Parwez MM, Pandya B. Metastatic Hepatic Epitheloid Hemangioendothelioma in a Young Male: A Rare Presentation. Gastrointest Tumors 2021; 8:58-62. [PMID: 33981683 DOI: 10.1159/000513963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
Hepatic EHE (epithelioid hemangioendothelioma) is an uncommon entity of vascular origin and a low-grade malignant tumor. Primary hepatic EHE is rare. These tumors can be multifocal at presentation like in the soft tissues, bones, brain, liver, and small intestine. First described by Weiss and Enzinger in 1982 as a malignant vascular neoplasm with indolent behavior. We report the case of a 23-year-old male, known case of chronic liver disease, who presented with incisional hernia following exploratory laparotomy 8 months back, performed for intestinal obstruction. Contrast-enhanced computed tomography abdomen revealed an incisional hernia with a large defect along with multiple lesions in the liver (suspected metastases) and peritoneal deposits and a few discrete lung nodules. Some areas of interloop collections were also noted. Biopsies were taken from the liver which revealed benign cirrhotic lesion. Relevant to the findings, multiple biopsies were performed and fluid was sent for evaluation. The liver biopsy came out positive for borderline vascular malignancy (epithelioid hemangioendothelioma). This was confirmed with the immunohistochemistry report. Epithelioid hemangioendothelioma occurs mostly in soft tissues of extremity and lungs. The involvement of the liver may be seen as metastasis or rarely as a primary tumor. The incidence of primary malignant hepatic hemangioendothelioma is about 0.1/100,000; the mean age at the time of diagnosis is 41.7 years, and male:female ratio is 2:3. Liver transplantation, hepatectomy, chemoembolization, radiotherapy, and chemotherapeutic agents are reported treatment regimens. Malignant EHE of liver presents as multiple hepatic nodules. Being locally aggressive, it can invade the peritoneum, gut, and lungs. Orthoptic liver transplantation appears to be the only remedy because of the multifocal nature of the disease. Partial hepatectomy is possible for localized tumors.
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Affiliation(s)
- Tanweerul Huda
- Department of General Surgery, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Bharati Pandya
- Department of General Surgery, AIIMS, Bhopal, Madhya Pradesh, India
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Kou K, Chen YG, Zhou JP, Sun XD, Sun DW, Li SX, Lv GY. Hepatic epithelioid hemangioendothelioma: Update on diagnosis and therapy. World J Clin Cases 2020; 8:3978-3987. [PMID: 33024754 PMCID: PMC7520791 DOI: 10.12998/wjcc.v8.i18.3978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/12/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
With an estimated incidence of only 1-2 cases in every 1 million people, hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular endothelial cell tumor occurring in the liver and consisting of epithelioid and histiocyte-like vascular endothelial cells in mucus or a fibrotic matrix. HEHE is characterized as a low-to-moderate grade malignant tumor and is classified into three types: solitary, multiple, and diffuse. Both the etiology and characteristic clinical manifestations of HEHE are unclear. However, HEHE has a characteristic appearance on imaging including ultrasound, magnetic resonance imaging, and positron emission tomography/computerized tomography. Still, its diagnosis depends mainly on pathological findings, with immunohistochemical detection of endothelial markers cluster of differentiation 31 (CD31), CD34, CD10, vimentin, and factor VIII antigen as the basis of diagnosis. Hepatectomy and/or liver transplantation are the first choice for treatment, but various chemotherapeutic drugs are reportedly effective, providing a promising treatment option. In this review, we summarize the literature related to the diagnosis and treatment of HEHE, which provides future perspectives for the clinical management of HEHE.
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Affiliation(s)
- Kai Kou
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Guo Chen
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jian-Peng Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Da-Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Shu-Xuan Li
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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8
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Abstract
Epithelioid hemangioendothelioma is a rare vascular tumor, composed of epithelioid and histiocytoid vascular endothelial cells in myxoid or fibrotic stroma, which can arise in multiple locations throughout the body. In the liver, this neoplasm usually presents on imaging as an incidental finding of multifocal, heterogeneously enhancing nodules in both lobes or presents clinically with nonspecific abdominal symptoms. Histologically, the tumor has been mistaken for metastatic carcinoma, angiosarcoma, hepatocellular carcinoma, and cholangiocarcinoma. The neoplasm usually stains positive for vascular markers, such as factor VIII-related antigen, CD31, and CD34, and negative for cytokeratins. The translocation t(1;3)(p36.3;q25), resulting in the CAMTA1- WWTR1 fusion product, is the most commonly identified genetic abnormality with this tumor. Although hepatic epithelioid hemangioendothelioma can have a varied clinical course, it is generally considered less aggressive than angiosarcoma. There is no consensus treatment protocol and techniques including liver transplantation, liver resection, chemotherapy and/or radiation therapy, and surveillance have all been used with varying outcomes.
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Lee JH, Jeong WK, Kim YK, Lee WJ, Ha SY, Kim KW, Kim J. Magnetic resonance findings of hepatic epithelioid hemangioendothelioma: emphasis on hepatobiliary phase using Gd-EOB-DTPA. Abdom Radiol (NY) 2017; 42:2261-2271. [PMID: 28365784 DOI: 10.1007/s00261-017-1119-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To examine the characteristic features of hepatic epithelioid hemangioendothelioma (HEH) on magnetic resonance imaging (MRI) using Gd-EOB-DTPA. MATERIAL AND METHODS Twelve patients (mean age, 50 years; male:female = 6:6) who were pathologically confirmed to have HEH in two tertiary institutions were retrospectively investigated. For qualitative analysis, the MRI features of HEH including core pattern were characterized, and lesions were divided into core and non-core groups. For quantitative analysis, standardized mean signal intensities (SIst) measured at the tumor center, periphery, and liver parenchyma were plotted against the dynamic phases. Differences in SIst between the core and non-core group were calculated for the tumor center and periphery. We also examined the radiologic and pathologic correlation for cases in which surgical resection was performed. RESULTS Forty-seven nodules in 12 patients were analyzed. The mean size of the lesions was 2.9 ± 1.0 cm. In the per-lesion analysis, ring-like arterial enhancement (74%) on arterial phase was the most frequent feature, followed by core pattern (51%), and hyperintense rim on T1-weighted imaging (43%). In the per-patient analysis, capsular retraction (75%) was the most common sign. The percentage of patients with core pattern was 58%. In the core group, the SIst of the center showed slow enhancement starting from the transitional phase, resulting in divergence between the two graphs throughout the entire dynamic study (p < 0.05). Pathologically, the lesion center consisted of reduced cellularity with myxohyaline stroma and necrosis. CONCLUSION Core pattern can be considered a new diagnostic sign of HEH.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Sang Yun Ha
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Won Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Alexander LF, Harri P, Little B, Moreno CC, Mittal PK. Magnetic Resonance Imaging of Primary Hepatic Malignancies in Patients With and Without Chronic Liver Disease: A Pictorial Review. Cureus 2017; 9:e1539. [PMID: 28989828 PMCID: PMC5628780 DOI: 10.7759/cureus.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Primary hepatic malignancies are less common than metastatic diseases, but a recognition of these lesions is important for diagnosis and treatment planning. Magnetic resonance imaging (MRI) provides the most imaging information to diagnose lesions noninvasively and to narrow differential diagnoses. This paper reviews the imaging findings of chronic liver disease and primary hepatic malignancies, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCA), epithelioid hemangioendothelioma, hepatic angiosarcoma, and primary hepatic lymphoma. Clinical and MRI features are reviewed to improve the readers’ recognition of these tumors, allowing for a narrower differential diagnosis when liver masses are encountered on abdominal imaging.
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Affiliation(s)
- Lauren F Alexander
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Peter Harri
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Brent Little
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
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Kabbach G, Assi HA, Bolotin G, Schuster M, Lee HJ, Tadros M. Hepatobiliary Tumors: Update on Diagnosis and Management. J Clin Transl Hepatol 2015; 3:169-81. [PMID: 26623263 PMCID: PMC4663198 DOI: 10.14218/jcth.2015.00012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 02/06/2023] Open
Abstract
Tumors of the liver and biliary tree, mainly hepatocellular carcinoma and cholangiocarcinoma, are the second leading cause of cancer related death worldwide and the sixth leading cause of cancer related death among men in developed countries. Recent developments in biomarkers and imaging modalities have enhanced early detection and accurate diagnosis of these highly fatal malignancies. These advances include serological testing, micro-ribonucleic acids, fluorescence in situ hybridization, contrast-enhanced ultrasound, and hepatobiliary-phase magnetic resonance imaging. In addition, there have been major developments in the surgical and nonsurgical management of these tumors, including expansion of the liver transplantation criteria, new locoregional treatments, and molecularly targeted therapies. In this article, we review various types of hepatobiliary tumors and discuss new developments in their diagnosis and management.
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Affiliation(s)
- Ghassan Kabbach
- Department of internal medicine, Albany medical center, Albany, NY, USA
| | - Hussein A Assi
- Department of internal medicine, Albany medical center, Albany, NY, USA
| | - George Bolotin
- Department of radiology, Albany medical center, Albany, NY, USA
| | | | - Hwa Jeong Lee
- Department of pathology, Albany medical center, Albany, NY, USA
| | - Micheal Tadros
- Department of internal medicine, Division of gastroenterology, Albany medical center, Albany, NY, USA
- Correspondence to: Micheal Tadros, Department of Medicine, Division of Gastroenterology, Albany Medical Center, 47 New Scotland Avenue, MC 48, Albany, NY 12208, USA. Tel: +1-518-262-5276, Fax: +1-518-262-6470, E-mail:
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12
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Zhou L, Cui MY, Xiong J, Dong Z, Luo Y, Xiao H, Xu L, Huang K, Li ZP, Feng ST. Spectrum of appearances on CT and MRI of hepatic epithelioid hemangioendothelioma. BMC Gastroenterol 2015; 15:69. [PMID: 26088585 PMCID: PMC4474347 DOI: 10.1186/s12876-015-0299-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/05/2015] [Indexed: 02/08/2023] Open
Abstract
Background This study aims to analyze the computed tomography (CT) and magnetic resonance imaging(MRI) characteristics of hepatic epithelioid hemangioendothelioma (HEHE). Methods Eleven patients with histopathologically confirmed HEHE via surgical excision or biopsy were included. Imaging findings of these 11 patients were retrospectively analyzed (CT images obtained from all patients and MR images from five patients). Patterns of growth, characteristics of distribution, density/signal features, patterns of contrast enhancement, and changes of adjacent tissues were evaluated. Results HEHE is characterized by multiple lesions in the liver. HEHE could be further categorized as three types when considering patterns of growth: nodular type(5 cases), coalescent type(1 case) and mixed type(5 cases). In this study, a total of 312 lesions were detected, 214(74.3 %) of which were subcapsular. All lesions appeared as hypodense while round lower density were found within 10 lesions(<2 cm) on unenhanced CT images. On MRI, all lesions demonstrated low signal intensity on T1 weighted images and high heterogeneous signal intensity on T2 weighted images when compared to the normal liver parenchyma. Other imaging features included “lollipop sign”(6 cases) and capsular retraction(6 cases). On contrast-enhanced CT and MRI, lesions smaller than 2.0 cm mostly showed mild homogeneous enhancement (214/227, 94.3 %); lesions measuring 2.0–3.0 cm in diameter showed ring-like enhancement (16/53,30.2 %) and heterogeneous delayed enhancement (29/53,54.7 %); lesions larger than 3.0 cm demonstrated heterogeneous delayed enhancement (26/32, 81.3 %). Conclusion The imaging findings of HEHE showed some typical imaging features and size-dependent patterns with contrast enhancement on both CT and MR images, these features can be used for accurate imaging diagnosis of HEHE.
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Affiliation(s)
- Lisha Zhou
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Min-Yi Cui
- Department of Radiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangdong, China.
| | - Juxin Xiong
- Department of Radiology, The Third People's Hospital of Dongguan City, Dongguan, China.
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Hui Xiao
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Ling Xu
- University of Western Australia, Perth, Australia.
| | - Kun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Gurung S, Fu H, Zhang WW, Gu YH. Hepatic epithelioid hemangioendothelioma metastasized to the peritoneum, omentum and mesentery: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:5883-5889. [PMID: 26191313 PMCID: PMC4503184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/15/2015] [Indexed: 06/04/2023]
Abstract
Epithelioid hemangioendothelioma (EHAE) is a malignant vascular tumor derived from endothelial cell often misdiagnosed as Hepatic carcinoma on the basis of radiological features. Till now etiology of this rare curiosity is unknown but it is related with use of oral contraceptives pills (OCP), liver trauma, exposure to vinyl chloride and hepatitis. We herein report on a case which failed to be diagnosed by cytopathology, computed tomography (CT) and magnetic resonance imaging (MRI). Patient was a 46 yr old man presented with abdominal distension for a month. Initial liver function test (LFT) was increased whereas renal function test (RFT) and alpha-fetoprotein (AFP) were normal. His abdominal ultrasound revealed multiple hypoechoic nodules and multiple liver calcifications. Subsequently laparoscopic omental biopsy and Ultrasound guided liver biopsy was done showing the neoplastic cells scattered in fibrous stroma. The immunohistochemistry for endothelial tumor cells stained positive for Vimentin (+++), CD10 (+++), CD34 (++), CD31 (+), Factor VIII antigen (focal) (+) and low proliferative activity for ki-67. Our case is very interesting in which patient admitted with nonspecific symptoms of abdominal pain and diagnosed to be a Malignant Hepatic EHAE metastasized to the peritoneum, omentum and mesentery. The patient was on thalidomide 50 mg/day and increased to 100 mg/day. 5-Flurouracil (FU) intraperitoneal chemotherapy and other symptomatic and supportive treatment was given to the patient. Our case highlights on the importance of immunohistopathological diagnosis, compare the radiological findings of this disease and discuss the treatment strategy with review of available literature.
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Affiliation(s)
- Sanita Gurung
- Department of Pathology, The Third Xiangya Hospital of Central South University, Changsha Hunan, P.R China
| | - Hua Fu
- Department of Pathology, The Third Xiangya Hospital of Central South University, Changsha Hunan, P.R China
| | - Wei Wen Zhang
- Department of Pathology, The Third Xiangya Hospital of Central South University, Changsha Hunan, P.R China
| | - Yong Hong Gu
- Department of Pathology, The Third Xiangya Hospital of Central South University, Changsha Hunan, P.R China
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Remiszewski P, Szczerba E, Kalinowski P, Gierej B, Dudek K, Grodzicki M, Kotulski M, Paluszkiewicz R, Patkowski W, Zieniewicz K, Krawczyk M. Epithelioid hemangioendothelioma of the liver as a rare indication for liver transplantation. World J Gastroenterol 2014; 20:11333-11339. [PMID: 25170219 PMCID: PMC4145773 DOI: 10.3748/wjg.v20.i32.11333] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/25/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the indications and outcomes of liver transplantation for hepatic epithelioid hemangioendothelioma (HEHE).
METHODS: Between 1989 and August 2013, in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1306 orthotopic liver transplantations (OLTx) were performed, including 72 retransplantations. Unresectable HEHE was an indication for OLTx in 10 patients (0.8% of primary OLTx), the mean age of the patients was 40.5 ± 13.3 years (range 23-65 years), and the male-to-female ratio was 2:8. Kaplan-Meier survival analysis in HEHE, hepatocellular carcinoma (HCC), and other OLTx recipients groups was performed. The differences in mortality were compared using the χ2 test. A P-value < 0.05 indicated statistical significance.
RESULTS: No concomitant liver disease was found in any patient. There was no neoadjuvant chemotherapy or radiotherapy. Liver function test results were normal in most of the patients. The levels of alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 were normal. In immunohistochemical staining, the neoplastic cells were positive for factor VIII-related antigen, CD31, and CD34, which are endothelial cell markers, and negative for cytokeratin 19, cytokeratin 7, and HepPar-1. Nine patients were alive without tumor recurrence. One patient died 2 mo after OLTx due to septic complications. No morbidity was observed. Maximum follow-up was 11.4 years, with a minimum of 1 mo. The cumulative survival rate at the end of follow-up in HEHE patients was 87.5% compared with 54.3% in the HCC group and 76.3% in the other OLTx recipients group (χ2 test = 1.784, df = 2, P = 0.409).
CONCLUSION: Unresectable HEHE, without extrahepatic metastases is an excellent indication for liver transplantation. Long-term survival is very good and much better than in HCC patients and the entire group of OLTx patients.
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