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Rammohan R, Joy M, Magam SG, Patel A, Magam SR, Natt D, Desai J, Bunting S, Mustacchia P. An Adult With Undifferentiated Embryonal Sarcoma of the Liver: A Case Report of a Rare Encounter. Cureus 2023; 15:e45018. [PMID: 37829956 PMCID: PMC10565881 DOI: 10.7759/cureus.45018] [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] [Accepted: 09/09/2023] [Indexed: 10/14/2023] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare, aggressive tumor mainly found in children but can also appear in adults. Its diagnosis in adults remains a conundrum; it is often identified late due to its non-specific symptoms and resemblance to benign lesions. A comprehensive treatment regimen involving surgical intervention, chemotherapy, and possibly radiation significantly boosts survival rates. Imaging often yields inconclusive outcomes, further complicating the diagnostic process. Here, we report the case of a 28-year-old female diagnosed with UESL, emphasizing the need for timely intervention. Undifferentiated embryonal sarcoma of the liver requires differentiation from a variety of hepatic tumors in adults. Though there are no distinctive characteristics to differentiate UESL from other hepatic masses, its morphology and immunohistochemical profiles significantly vary. The staging often reveals UESL as a large, well-defined mass with the potential for diverse differentiation. Its prognosis has been considerably improved with the advent of multidisciplinary treatment. Surgical resection remains a cornerstone, often combined with chemotherapy. While pediatric cases exhibit better overall survival rates than adults, outcomes heavily depend on the chosen treatment regimen. A combination of chemotherapy and complete tumor removal has been found to significantly elevate survival chances. Disease recurrence remains a challenge and is influenced by treatment strategy. In conclusion, the diagnosis and treatment of UESL are fraught with challenges, particularly in adults. A multidimensional approach, combining various therapies, is paramount for better outcomes. Continuous research and enhanced awareness are crucial for improving diagnostic precision and treatment outcomes for UESL patients.
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Affiliation(s)
- Rajmohan Rammohan
- Gastroenterology, Nassau University Medical Center, East Meadow, USA
| | - Melvin Joy
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | | | - Achal Patel
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Sai Reshma Magam
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Dilman Natt
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Jiten Desai
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Susan Bunting
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Paul Mustacchia
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
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2
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Suárez A, Suaza Vallejo MC, Brito J, Luengas JP, Mesa J. Undifferentiated Embryonal Sarcoma of the Liver in Pediatrics: A Diagnostic Challenge With Implications for Early Management. Cureus 2023; 15:e44923. [PMID: 37814737 PMCID: PMC10560589 DOI: 10.7759/cureus.44923] [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] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
A 10-year-old boy was evaluated for intermittent colicky abdominal pain, general malaise, and asthenia. Imaging revealed a solid liver lesion. Subsequent biopsy and extension studies diagnosed the lesion as undifferentiated embryonal sarcoma of the liver, classified as PRETEXT II, group III according to the postoperative staging system of the Intergroup Study for Soft Tissue Sarcomas. He underwent neoadjuvant chemotherapy using alternating cycles of ifosfamide, doxorubicin, vincristine, D-actinomycin, and cyclophosphamide. This was followed by surgical intervention and two additional adjuvant chemotherapy cycles, resulting in a complete disease response. The patient remains in follow-up and shows no signs of relapse 28 months post-diagnosis. Undifferentiated embryonal sarcoma of the liver is a rare and often misdiagnosed condition that can be mistaken for a benign disease. Its prognosis hinges on timely and accurate diagnosis, which is essential for effectively treating patients with this aggressive pathology with a high mortality risk. Notably, there is no standard treatment approach. In our case, we implemented therapeutic strategies from various literature reports, yielding a promising outcome and positive patient progression.
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Affiliation(s)
- Amaranto Suárez
- Pediatric Oncology, Instituto Nacional de Cancerología, Bogotá, COL
| | | | - Javier Brito
- Pediatric Oncology, Instituto Nacional de Cancerología, Bogota, COL
| | - Juan Pablo Luengas
- Hematology and Oncology, Instituto Nacional de Cancerología, Bogota, COL
| | - Jorge Mesa
- Pathology, Instituto Nacional de Cancerología, Bogotá, COL
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3
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Cekuolis A, Schreiber-Dietrich D, Augustinienė R, Taut H, Squires J, Chaves EL, Dong Y, Dietrich CF. Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients. Cancers (Basel) 2023; 15:cancers15082360. [PMID: 37190288 DOI: 10.3390/cancers15082360] [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: 02/22/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental imaging findings-the role of ultrasound". IFs in the liver of newborns and children are rare and much less commonly encountered than in adults; as a result, they are relatively much more frequently malignant and life-threatening, even when they are of benign histology. Conventional B-mode ultrasound is the well-established first line imaging modality for the assessment of liver pathology in pediatric patients. US technological advances, resulting in image quality improvement, contrast-enhanced ultrasound (CEUS), liver elastography and quantification tools for steatosis have expanded the use of ultrasound technology in daily practice. The following overview is intended to illustrate incidentally detected liver pathology covering all pediatric ages. It aims to aid the examiner in establishing the final diagnosis. Management of incidentally detected focal liver lesions (FLL) needs to take into account the diagnostic accuracy of each imaging modality, the patient's safety issues (including ionizing radiation and nephrotoxic contrast agents), the delay in diagnosis, the psychological burden on the patient and the cost for the healthcare system. Moreover, this paper should help the pediatric clinician and ultrasound practitioner to decide which pathologies need no further investigation, which ones require interval imaging and which cases require further and immediate diagnostic procedures.
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Affiliation(s)
- Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | | | - Rasa Augustinienė
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01062 Dresden, Germany
| | - Judy Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Edda L Chaves
- Radiology Department, Hospital Regional Nicolas Solano, La Chorrera 1007, Panama
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, 3013 Bern, Switzerland
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4
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Mohamed EM, Zeidan M, Gazzaz TF, Abdullah NS, Abolyazid SM, Elaryan A. Undifferentiated embryonal sarcoma of liver arising within mesenchymal hamartoma in a child "case report". THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00871-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary pediatric liver tumors are scarce. Undifferentiated embryonal sarcoma of the liver (UESL) embraces nine to fifteen percent of the pediatric hepatic neoplasms. Mesenchymal hamartoma of the liver (MHL) is the second most prevalent benign pediatric hepatic neoplasm following infantile hemangioendothelioma.
Case presentation
A 6-year-old female child presented with vague diffuse abdominal pain and palpable right lumbar mass by clinical examination. The US showed a well-circumscribed large right hepatic complex multilocular cystic lesion with multiple internal septations and some turbid loculi. The constellation of CT and dynamic MRI findings raised the presence of atypical suspicious complex cystic hepatic mass lesion with hemorrhagic, calcific entities and internal soft tissue enhancement. The histopathological correlation proved UESL on the background of MHL.
Conclusions
A case of a pediatric hepatic complex cystic lesion, which had typical ultrasound features of MHL, however, CT and MRI had atypical suspicious criteria. Finally, our case is presented as UESL in the background of MHL based upon pathological diagnosis. The radiologists must be familiar with overlapped entities between MHL, UESL, and other differential diagnosis entities regarding pediatric hepatic neoplasms.
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Jiang P, Jiao Y, Niu CY, Liu YH. Undifferentiated embryonal sarcoma of the liver with epithelioid features in an adult patient: A case report. Medicine (Baltimore) 2021; 100:e28265. [PMID: 34918699 PMCID: PMC10545351 DOI: 10.1097/md.0000000000028265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Undifferentiated embryonal sarcoma of the liver (UESL) is a rare form of liver malignancy, with most cases reported in the pediatric population. This disease is extremely uncommon in adults. Herein, we report the first case of UESL with epithelioid features in an adult patient. PATIENT CONCERNS A 50-year-old man was admitted to our hospital due to epigastric pain. DIAGNOSIS AND INTERVENTIONS Computed tomography and magnetic resonance imaging revealed a space-occupying lesion in the right lobe of the liver. A right hemihepatectomy was performed. Postoperative pathological and immunohistochemical examinations confirmed the diagnosis of UESL and features of epithelioid differentiation. OUTCOMES The patient recovered well and refused adjuvant therapy. Unfortunately, the patient died of tumor recurrence 3 months after hospital discharge. CONCLUSION UESL is a rare form of liver cancer, with most cases reported in the pediatric population. This case study highlights an extremely uncommon case of UESL with epithelioid features and a very poor prognosis. The findings suggest that complete intraoperative resection and postoperative adjuvant therapy should be considered to improve the prognosis of adult patients with UESL with epithelioid features.
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Lucas B, Ravishankar S, Pateva I. Pediatric Primary Hepatic Tumors: Diagnostic Considerations. Diagnostics (Basel) 2021; 11:333. [PMID: 33670452 PMCID: PMC7922091 DOI: 10.3390/diagnostics11020333] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is the third most common site of abdominal tumors in children. This review article aims to summarize current evidence surrounding identification and diagnosis of primary hepatic tumors in the pediatric population based upon clinical presentation, epidemiology, and risk factors as well as classical imaging, histopathological, and molecular diagnostic findings. Readers will be able to recognize the features and distinguish between benign and malignant hepatic tumors within different age groups.
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Affiliation(s)
- Bryony Lucas
- Rainbow Babies and Children’s Hospital—Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Sanjita Ravishankar
- Rainbow Babies and Children’s Hospital—Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Irina Pateva
- Rainbow Babies and Children’s Hospital—Department of Pediatric Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Undifferentiated embryonal sarcoma of liver. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Murawski M, Scheer M, Leuschner I, Stefanowicz J, Bonar J, Dembowska-Bagińska B, Kaliciński P, Koscielniak E, Czauderna P, Fuchs J. Undifferentiated sarcoma of the liver: Multicenter international experience of the Cooperative Soft-Tissue Sarcoma Group and Polish Paediatric Solid Tumor Group. Pediatr Blood Cancer 2020; 67:e28598. [PMID: 32706511 DOI: 10.1002/pbc.28598] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Undifferentiated embryonal sarcomas of the liver (UESL) are extremely rare and continue to pose a diagnostic and therapeutic challenge. The aim of the study was to present a multicenter experience of the German CWS and Polish PPSTG groups in the treatment of UESL in children. PROCEDURE Twenty-five patients were treated according to the CWS-96, CWS-2002, and CYVADIC protocols. Distant metastases were observed in four cases (16%). In four cases, an initial disease presentation mimicked other entities. A pure cystic appearance of liver mass led to misdiagnosis of hydatid cyst in three cases. In one case, laparotomy was performed due to the signs of appendicitis, and bleeding from ruptured liver tumor was found. All these patients were finally diagnosed as UESL. RESULTS Thirteen patients received preoperative chemotherapy. Partial response was observed in 10 cases. Tumor resection was performed in 20 patients (primary resections, 12; delayed resections-, 8). In five patients, the primary tumor never became operable. The macroscopically complete resection rate was 95% (19/20). Postoperative chemotherapy was given to 20 children. Local radiotherapy was used in three children. After a median follow-up time of 136 months, 17 patients (68%) were alive with no evidence of disease. All children with unresectable tumor and three out of four patients with distant metastases died. The five-year overall survival (OS) rate was 72%. CONCLUSIONS In summary, a complete tumor excision plays the central role in the treatment of UESL. A cystic presentation of the liver lesion on imaging does not exclude the diagnosis of malignant tumor.
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Affiliation(s)
- Maciej Murawski
- Deptartment of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Monika Scheer
- Department of Pediatric Hematology, Oncology and Immunology, Olgahospital, Klinikum Stuttgart, Germany
| | - Ivo Leuschner
- Department of Pediatric Hematology, Oncology and Immunology, Olgahospital, Klinikum Stuttgart, Germany.,Department of Pediatric Pathology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Joanna Stefanowicz
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jolanta Bonar
- Department of Bone Marrow Transplantation, Children Oncology and Haematology, Medical University of Wroclaw, Wroclaw, Poland
| | | | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - Ewa Koscielniak
- Department of Pediatric Hematology, Oncology and Immunology, Olgahospital, Klinikum Stuttgart, Germany
| | - Piotr Czauderna
- Deptartment of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany
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9
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Zhang C, Jia CJ, Xu C, Sheng QJ, Dou XG, Ding Y. Undifferentiated embryonal sarcoma of the liver: Clinical characteristics and outcomes. World J Clin Cases 2020; 8:4763-4772. [PMID: 33195644 PMCID: PMC7642548 DOI: 10.12998/wjcc.v8.i20.4763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Undifferentiated embryonal sarcoma of the liver (UESL) is a rare liver malignancy originating from primary mesenchymal tissue. The clinical manifestations, laboratory tests, and imaging examinations of the disease lack specificity and the preoperative misdiagnosis rate is high. The overall prognosis is poor and survival rate is low.
AIM To investigate the diagnosis, treatment, and prognosis of UESL.
METHODS We performed a retrospective, single-center cohort study in Shengjing Hospital of China Medical University, which is a central hospital in northeast China. From 2005 to 2017, we recruited 14 patients with pathologically confirmed UESL. We analyzed the clinical manifestations, laboratory tests, imaging examinations, pathological examinations, therapy, and prognosis of these patients.
RESULTS There were nine males and five females aged 2-60 years old included in the study. The major initial symptoms were abdominal pain (71.43%) and fever (57.14%). Preoperative laboratory tests revealed that seven patients had increased leukocyte levels, four showed a decrease in hemoglobin levels, seven patients had increased glutamyl transpeptidase levels, nine had increased lactate dehydrogenase levels, and three showed an increase in carbohydrate antigen 199. There was no difference in the rate of misdiagnosis in preoperative imaging examinations of UESL between adults and children (6/6 vs 5/8, P = 0.091). The survival rate after complete resection was 6/10, while that after incomplete resection was 0/4 (P = 0.040), suggesting that complete resection is important to improve survival rate. In total, five out of the eight children achieved survival. During the follow-up, the maximum survival time was shown to be 11 years and minimum survival time was 6 mo. Six adult patients relapsed late after surgery and all of them died.
CONCLUSION Preoperative imaging examination for UESL has a high misdiagnosis rate. Multidisciplinary collaboration can improve the diagnostic accuracy of UESL. Complete surgical resection is the first choice for treatment of UESL.
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Affiliation(s)
- Chong Zhang
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Chang-Jun Jia
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Can Xu
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Qiu-Ju Sheng
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Xiao-Guang Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
| | - Yang Ding
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
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Thombare P, Verma M, Shah K, Doshi H, Verma G, Patkar D. Undifferentiated embryonal sarcoma of liver: Paradoxical imaging appearance. Radiol Case Rep 2020; 15:1095-1098. [PMID: 32489512 PMCID: PMC7256223 DOI: 10.1016/j.radcr.2020.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 01/11/2023] Open
Abstract
Undifferentiated embryonal sarcoma of the liver is a rare entity. It is a malignant primitive mesenchymal tumor seen in the pediatric age group often between 6 to 10 years of age. It involves the right lobe of the liver commonly and is usually asymptomatic. Acute presentation in these cases is secondary to its rupture/ wall dehiscence. Alfa fetoprotein, a tumor marker elevated in most of the hepatic malignant tumors is however normal in undifferentiated embryonal sarcoma. Imaging wise it is a large encapsulated multiseptated lesion. It shows a “paradoxical appearance” with a predominantly solid appearance on ultrasonography and cystic appearance on CT/MRI. This is a peculiar feature that can help in the early diagnosis of this entity. Besides, normal serum alfa fetoprotein levels favor its diagnosis. Hereby we present a case of a 5-year-old female child, presented with complaints of acute onset abdominal pain and distension which on imaging investigation showed a liver mass with typical paradoxical appearance on ultrasonography, CT and MRI as described.
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Affiliation(s)
| | | | - Kant Shah
- Nanavati Super-Speciality Hospital, Mumbai, India
| | - Hiren Doshi
- Nanavati Super-Speciality Hospital, Mumbai, India
| | - Gita Verma
- Nanavati Super-Speciality Hospital, Mumbai, India
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Abstract
Mesenchymal tumors in childhood comprise benign and malign entities and differ regarding typical sites of manifestation, age peak and clinical symptoms. In some cases biopsy is mandatory. If nephroblastoma is a possible diagnosis, biopsy must be avoided by all means in order to avoid biopsy tract metastasis. Imaging is used to narrow the differential diagnosis, describe the exact extent of the lesion and deliver complete staging. In pediatric patients sonography and MRI are the most important imaging modalities. Low-dose CT of the thorax serves for assessment of possible pulmonary metastases.
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Affiliation(s)
- G A Krombach
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Giessen, Justus-Liebig Universität Giessen, Klinikstraße 33, 35392, Giessen, Deutschland.
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12
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Kamrani K, Patel A, Guerrieri C, Bethel CAI, Phatak T. Undifferentiated embryonal sarcoma of the liver mimicking venolymphatic malformation. Radiol Case Rep 2019; 14:795-799. [PMID: 31011382 PMCID: PMC6462802 DOI: 10.1016/j.radcr.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/03/2019] [Indexed: 12/30/2022] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a primitive hepatic neoplasm that presents in a variety of forms on ultrasonography, computed tomography, and magnetic resonance imaging. In this case report, we present an UESL with fluid-fluid cysts mimicking a radiographic presentation commonly seen in venolymphatic malformation on magnetic resonance imaging. This is the first described case of UESL, with this radiographic presentation and outlines, the importance of considering this malignant lesion when evaluating liver tumors in children.
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Affiliation(s)
- Kambiz Kamrani
- Department of Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
- Corresponding author.
| | - Anshu Patel
- School of Medicine, Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA
| | - Claudio Guerrieri
- Department of Pathology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
| | | | - Tej Phatak
- Department of Radiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
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Undifferentiated embryonal sarcoma of the liver in a child: A whole exome sequencing analysis. Dig Liver Dis 2017; 49:944-946. [PMID: 28539230 DOI: 10.1016/j.dld.2017.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 12/11/2022]
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14
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Giakoustidis DE, Gargavanis AA, Katsiki ED, Salveridis NT, Antoniadis NA, Papanikolaou V. Undifferentiated embryonal sarcoma of the liver in a young female: treatment with portal vein embolization and liver trisectonectomy. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2016; 20:144-7. [PMID: 27621753 PMCID: PMC5018947 DOI: 10.14701/kjhbps.2016.20.3.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/17/2016] [Accepted: 04/22/2016] [Indexed: 01/06/2023]
Abstract
Undifferentiated Embryonal Sarcoma of the Liver (UESL) is a tumor highly malignant, of mesenchymal origin. It is a rare finding in adults, though less rare in children. The strategy to be followed and the therapeutic targets to be reached for this tumor, in adult cases, remain ambiguous and controversial. Herein we report the case of a 29 year old female patient with a massive UESL and we describe our therapeutic approach. A 29 year-old female patient was referred to our center with severe intermittent epigastric pain and fever due to a voluminous liver tumor: Needle biopsy was of no specific findings and surgical excision was decided. Right portal vein embolization and selective embolization of the segment's IV branch was performed in order to achieve adequate future liver remnant (FLR). Right trisectonectomy was then performed, with uneventful post operative period and the patient was discharged at the 11(th) post operative day. UESL is a rare tumor that needs aggressive surgical approach and multidisciplinary team management is of paramount importance.
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Affiliation(s)
- Dimitrios E Giakoustidis
- Division of Transplant Surgery, Department of Surgery, Medical School, Aristotle University of Thessaloniki and Hippokration General Hospital, Thessaloniki, Greece
| | - Athanasios A Gargavanis
- Division of Transplant Surgery, Department of Surgery, Medical School, Aristotle University of Thessaloniki and Hippokration General Hospital, Thessaloniki, Greece
| | - Evangelia D Katsiki
- Department of Pathology, Hippokration General Hospital, Thessaloniki, Greece
| | - Nikolaos T Salveridis
- Division of Transplant Surgery, Department of Surgery, Medical School, Aristotle University of Thessaloniki and Hippokration General Hospital, Thessaloniki, Greece
| | - Nikolaos A Antoniadis
- Division of Transplant Surgery, Department of Surgery, Medical School, Aristotle University of Thessaloniki and Hippokration General Hospital, Thessaloniki, Greece
| | - Vasileios Papanikolaou
- Division of Transplant Surgery, Department of Surgery, Medical School, Aristotle University of Thessaloniki and Hippokration General Hospital, Thessaloniki, Greece
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15
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Zhao X, Xiong Q, Wang J, Li MJ, Qin Q, Huang S, Gu W, Shu Q, Tou J. Preoperative Interventional Therapy for Childhood Undifferentiated Embryonal Liver Sarcoma: Two Retrospective Cases from a Single Center. European J Pediatr Surg Rep 2015; 3:90-3. [PMID: 26788456 PMCID: PMC4712051 DOI: 10.1055/s-0035-1566219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 09/17/2015] [Indexed: 02/07/2023] Open
Abstract
Background Undifferentiated embryonal liver sarcoma (UELS) accounts for only 9 to 15% of all malignant liver tumors in children. Typically, UELS occurs in older children and presents as an abdominal mass. Most UELS are unresectable because of the later diagnosis. The outcome of UELS is very poor, with a 5-year overall survival of < 37.5%. Transarterial chemoembolization (TACE) has been reported to be an effective modality for unresectable liver tumors. To investigate the effects of TACE on UELS in children, we present two cases of children with UELS who underwent TACE and surgical resection in our center within the past 10 years. Methods In this study, two children with UELS were treated using TACE with cisplatin, doxorubicin, and iodized oil. The size of the tumors was measured before and after TACE using ultrasonography. Routine was also given before and after surgical resection. Side effects were recorded. Both patients had follow-up. Results After interventional therapy, both patients presented with vomiting, fever, and transient liver dysfunction without cardiac or renal dysfunction. One patient had bone marrow depression. The size of the tumors was reduced by 23% to 31% after TACE. The tumors were completely removed by surgical procedures after 4 weeks of TACE in both patients. One patient survived free of disease for 1 year, and the other survived free of disease for 9 years. Conclusion TACE yielded satisfactory results for unresectable UELS in children, with lower dosage of chemotherapy and fewer side effects. It may be applied as a preoperative therapy for children with unresectable UELS.
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Affiliation(s)
- Xiaoxia Zhao
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qixing Xiong
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinhu Wang
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Min-Ju Li
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qi Qin
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shoujiang Huang
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weizhong Gu
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiang Shu
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinfa Tou
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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16
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Hanafiah M, Yahya A, Zuhdi Z, Yaacob Y. A case of an undifferentiated embryonal sarcoma of the liver mimicking a liver abscess. Sultan Qaboos Univ Med J 2014; 14:e578-e581. [PMID: 25364566 PMCID: PMC4205075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 04/02/2014] [Accepted: 05/15/2014] [Indexed: 06/04/2023] Open
Abstract
An undifferentiated embryonal sarcoma of the liver is a rare malignant tumour. We highlight the diagnostic dilemma and differential diagnosis of a case involving a large cystic liver lesion in a young adult. A 20-year-old man presented with a large liver lesion to the Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia, in February 2012. The initial clinico-radiological presentations were suggestive of a liver abscess. A total tumour resection was performed and the final histopathological results of the resected specimen indicated an undifferentiated embryonal sarcoma of the liver. The ultrasound and computed tomographic images of the tumour were reviewed and found to be contradictory in appearance, as the tumour seemed predominantly solid in the ultrasound image and predominantly cystic in the computed tomographic image. Familiarisation with the imaging appearance of this tumour and a high index of suspicion is therefore crucial in making a successful diagnosis.
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Affiliation(s)
| | - Azyani Yahya
- Departments of Pathology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Zamri Zuhdi
- Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Yazmin Yaacob
- Radiology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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17
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He B, Xu K, Huang K, Huang Y, Li P, Chen Z, Shi H, Zhang Q, Shan Y. Undifferentiated embryonal liver sarcoma in childhood: A case report. Oncol Lett 2014; 8:1127-1132. [PMID: 25120671 PMCID: PMC4114632 DOI: 10.3892/ol.2014.2262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 04/16/2014] [Indexed: 12/27/2022] Open
Abstract
In order to improve the diagnosis and therapy of undifferentiated embryonal liver sarcoma (UELS), the present study presents the case of a 9-year-old female with UELS and discusses UELS in childhood. The patient presented with abdominal pain and fever. The laboratory tests, radiographic examination and pathological features presented by the female were similar to those of typical cases of UELS reported in childhood. The patient initially received surgical treatment and the immunohistochemical findings suggested that the patient had UELS. The patient’s parents refused adjuvant chemotherapy and demonstrated a right prerenal mass 6 months post-surgery. Microscopic examination revealed that the tumor was evidence of undifferentiated embryonal sarcoma recurrence. However, the patient was comfortable and physical examination revealed no abnormal conditions. In addition, the laboratory results were normal. Abdominal computed tomography scan and ultrasound were performed every 3 months to monitor the tumor recurrence. At the time of writing, it has been 6 months after the second surgical procedure and there has been no appearence of abnormalities. Previous studies have shown that patients who receive combined therapy with complete tumor resection and adjuvant chemotherapy have a longer survival time than those who undergo surgical therapy alone. Complete tumor resection combined with adjuvant chemotherapy may reduce the risk of recurrence and enhance the survival time in patients with UELS.
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Affiliation(s)
- Bin He
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Keyu Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Kate Huang
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yuehan Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Peng Li
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhenkun Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Hongqi Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Qiyu Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yunfeng Shan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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18
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Xie S, Wu X, Zhang G, Xu K, Bian X, Zhang S, Ye Y. Remarkable regression of a lung recurrence from an undifferentiated embryonal sarcoma of the liver treated with a DC vaccine combined with immune cells: a case report. Cell Immunol 2014; 290:185-9. [PMID: 25038546 DOI: 10.1016/j.cellimm.2014.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/27/2014] [Accepted: 05/31/2014] [Indexed: 11/30/2022]
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant tumor that occurs predominantly in children and has a poor prognosis. Here, we report a novel case in which the UESL presented in the left lobe of the liver and metastasized into both lungs after surgical resection. The patient recovered after our administration of an immunotherapeutic combination of DCs (Dendritic Cells) and multi-immune cells, such as cytokine-induced killer cells (CIKs) and natural killer cells (NKs). After the third cycle of immunotherapy, a CT scan showed a remarkable regression of the lung metastases. This finding supports the conclusion that the DC-based treatment is a promising potential strategy for treating patients with relapsed UESL.
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Affiliation(s)
- Shangyun Xie
- Department of R&D, Shanghai Claison Bio-tech Co., Ltd, Shanghai 201201, China
| | - Xiao Wu
- Department of R&D, Shanghai Claison Bio-tech Co., Ltd, Shanghai 201201, China
| | - Guoliang Zhang
- Department of R&D, Shanghai Claison Bio-tech Co., Ltd, Shanghai 201201, China; Bio-therapic Treatment Center, Department of Oncology, Chinese Armed Police General Shan Dong Hospital, Shangdong, Jinan 250014, China
| | - Ke Xu
- Department of R&D, Shanghai Claison Bio-tech Co., Ltd, Shanghai 201201, China
| | - Xiaoshan Bian
- Bio-therapic Treatment Center, Department of Oncology, Chinese Armed Police General Shan Dong Hospital, Shangdong, Jinan 250014, China
| | - Shufang Zhang
- Affiliated Haikou Hospital, Xiangya School of Medicine Central South University, Haikou Municipal People's Hospital, Haikou, China
| | - Yongqing Ye
- Department of R&D, Shanghai Claison Bio-tech Co., Ltd, Shanghai 201201, China.
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