Contrast enhanced ultrasound of a hepatic soft tissue angiosarcoma metastasis. Case report

Low-grade myofibroblastic sarcoma of the liver misdiagnosed as cystadenoma: A case report

BACKGROUND

Low-grade myofibroblastic sarcoma (LGMS) is a rare malignant tumor. It has no specific clinical manifestations and commonly occurs in the head and neck, extremities and other body parts, with the liver not as its predisposing site.

CASE SUMMARY

We report a case report of a 58-year-old man with right upper abdominal pain for 11 d. Contrast-enhanced computed tomography (CECT), CE magnetic resonance imaging and CE ultrasound (US) all showed a cystic-solid mass in the right liver. As the initial clinical diagnosis was hepatic cystadenoma, surgical resection was performed, and the postoperative pathology indicated hepatic LGMS. The 3-mo follow-up showed favorable recovery of the patient. However, at 7-mo follow-up, two-dimensional US and CECT showed a suspected metastatic lesion in the right-middle abdomen.

CONCLUSION

Hepatic MS is particularly rare and easily misdiagnosed, more cases will contribute to the understanding and the diagnosis accuracy.

Uncommon liver tumors: Case report and literature review

BACKGROUND

Beside hepatocellular carcinoma, metastasis, and cholangiocarcinoma, the imaging findings of other relatively uncommon hepatic lesions are less discussed in the literature. Imaging diagnosis of these lesions is a daily challenge. In this article, we review the imaging characteristics of these neoplasms.

METHODS

From January 2003 to December 2014, 4746 patients underwent liver biopsy or hepatic surgical resection in our hospital. We reviewed the pathological database retrospectively. Imaging of these lesions was reviewed.

RESULTS

Imaging findings of uncommon hepatic lesions vary. We discuss the typical imaging characteristics with literature review. Clinical and pathological correlations are also described. Primary hepatic lymphoma consists only of 1% of the extranodal non-Hodgkin lymphoma, and is defined as the one involving only the liver and perihepatic lymph nodes within 6 months after diagnosis. Combined hepatocellular and cholangiocarcinoma (cHCC-CC) shares some overlapping imaging characteristics with both HCC and cholangiocarcinoma because of being an admixture of them. Angiosarcoma is the most common hepatic mesenchymal tumor and is hypervascular in nature. Inflammatory pseudotumor is often heterogeneous on ultrasonography and with enhanced septations and rims in the portovenous phase after contrast medium. Angiomyolipoma (AML) typically presents with macroscopic fat components with low signal on fat-saturated magnetic resonance imaging (MRI) and presence of drainage vessels. Intraductal papillary neoplasm of the bile duct (IPNB) is thought of as a counterpart to the pancreatic intraductal papillary mucinous neoplasm. Most of the IPNBs secrete mucin and cause disproportional dilatation of the bile ducts. Mucinous cystic neoplasm (MCN) contains proteinaceous and colloidal components without ductal communication and characterizes with hyperintensity on T1-weighted imaging. Other extremely rare lesions, including epithelioid hemangioendothelioma and inflammatory pseudotumor-like follicular dendritic cell sarcoma, are also discussed. Hepatoblastoma and mesenchymal hamartoma, mostly in children, are also briefly reviewed as well.

CONCLUSION

It is important for radiologists to be familiar with the typical imaging features of the uncommon hepatic neoplasms. If imaging findings are not typical or diagnostic, further biopsy is required.