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Okamoto T, Sasaki T, Takahashi Y, Takamatsu M, Kanda H, Hiratsuka M, Matsuyama M, Ozaka M, Sasahira N. Perivascular epithelioid cell tumor (PEComa) of the cystic duct. Clin J Gastroenterol 2023; 16:87-95. [PMID: 36309916 DOI: 10.1007/s12328-022-01730-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/23/2022] [Indexed: 02/03/2023]
Abstract
Perivascular epithelioid cell tumors, also known as PEComas, are rare mesenchymal tumors composed mainly of epithelioid cells found in perivascular tissue. PEComas occur most frequently in the kidney, uterus, the gastrointestinal tract, liver, and retroperitoneum; those originating in the biliary tree are extremely rare. We report a case of benign PEComa of the cystic duct with positive TFE3 staining on immunohistochemistry.A 66-year-old woman was referred for a 20 mm mass adjacent to the common bile duct discovered incidentally on abdominal ultrasound. Laboratory data including tumor markers were unremarkable. The tumor appeared to arise from the cystic duct, showed early enhancement, and compressed the common bile duct on imaging studies. Endoscopic ultrasound-guided fine-needle aspiration revealed round- and spindle-shaped atypical cells with eosinophilic cytoplasm and brown deposits suggestive of melanin granules. Histological examination of the resected specimen revealed a tumor consisting of epithelioid cells forming an alveolar structure, with melanin pigmentation. Immunohistochemistry was positive for HMB-45 and TFE3, consistent with benign pigmented PEComa of the cystic duct. Melanotic, myogenic, and TFE3 staining are helpful when diagnosing PEComas arising in unusual locations.
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Affiliation(s)
- Takeshi Okamoto
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
| | - Yu Takahashi
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-Ku, AriakeTokyo, 135-8550, Japan
| | - Manabu Takamatsu
- Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Hiroaki Kanda
- Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Makiko Hiratsuka
- Department of Diagnostic Imaging, Diagnostic Imaging Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Masato Matsuyama
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
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Barat M, Guegan-Bart S, Cottereau AS, Guillo E, Hoeffel C, Barret M, Gaujoux S, Dohan A, Soyer P. CT, MRI and PET/CT features of abdominal manifestations of cutaneous melanoma: a review of current concepts in the era of tumor-specific therapies. Abdom Radiol (NY) 2021; 46:2219-2235. [PMID: 33135115 DOI: 10.1007/s00261-020-02837-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
Abdominal manifestations in patients with cutaneous melanoma include involvement due to metastatic spread and immune checkpoint inhibitor induced adverse events. The purpose of this review is to provide a critical overview of abdominal manifestations in patients with cutaneous melanoma and highlight the current imaging challenges in the era of tumor-specific therapies. Immune checkpoint inhibitors represent a treatment with demonstrated efficacy in the treatment of advanced cutaneous melanoma but are associated with several abdominal adverse events that must be recognized. CT has a role in the identification of colitis, enteritis and pancreatitis, whereas MRI has an important role in the diagnosis of autoimmune pancreatitis. Current evidence demonstrates that MRI should be the preferred imaging technique for the detection and characterization of hepatic and splenic metastases from cutaneous melanoma. The role of 18F-FDG-PET/CT should be further evaluated but current literature suggests an efficacy in the detection of pancreatic metastases not seen on CT and MRI.
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Affiliation(s)
- Maxime Barat
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université de Paris, Descartes-Paris 5, rue de l'Ecole de Médecine, F-75006, Paris, France
| | - Sarah Guegan-Bart
- Université de Paris, Descartes-Paris 5, rue de l'Ecole de Médecine, F-75006, Paris, France
- Department of Dermatology, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Anne-Ségolène Cottereau
- Université de Paris, Descartes-Paris 5, rue de l'Ecole de Médecine, F-75006, Paris, France
- Department of Nuclear Medicine, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Enora Guillo
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré, 11 Boulevard Pasteur, 51092, Reims, France
| | - Maximilien Barret
- Université de Paris, Descartes-Paris 5, rue de l'Ecole de Médecine, F-75006, Paris, France
- Department of Gastroenterology, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Sébastien Gaujoux
- Université de Paris, Descartes-Paris 5, rue de l'Ecole de Médecine, F-75006, Paris, France
- Department of Abdominal Surgery, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Anthony Dohan
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université de Paris, Descartes-Paris 5, rue de l'Ecole de Médecine, F-75006, Paris, France
| | - Philippe Soyer
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
- Université de Paris, Descartes-Paris 5, rue de l'Ecole de Médecine, F-75006, Paris, France.
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Granata V, Fusco R, Catalano O, Filice S, Avallone A, Piccirillo M, Leongito M, Palaia R, Grassi R, Izzo F, Petrillo A. Uncommon neoplasms of the biliary tract: radiological findings. Br J Radiol 2017; 90:20160561. [PMID: 28731820 DOI: 10.1259/bjr.20160561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To report our cancer centre experience in the biliary tumours incidence other than cholangiocellular-carcinoma, emphasizing the radiological features. METHODS 197 patients with biliary disease undergoing Gd-EOB-DTPA-enhanced MRI were reviewed. Four radiologists evaluated retrospectively size, structure, anatomical site and signal intensity of lesions on MRI. Enhancement-pattern during the arterial-, portal- and late-phase on ultrasound, CT and MR study was assessed as well as the enhancement pattern during the hepatobiliary-phase on MRI. RESULTS 23 patients were selected. The lesion was intraductal in 5 cases, periductal in 14 and intrahepatic in 4. 16 lesions were solid, 5 uniloculated cystic and 2 complex cystic. In five patients the lesion was simple cyst, with a signal intensity in T1 weighted (T1W) and T2 weighted (T2W) similar to the gallbladder. In two patients with complex cystic lesion, the solid component was heterogeneously hypointense in T1 W, hyperintense in T2 W with a restricted diffusion. The solid component showed heterogeneous contrast-enhancement on CT, MR and ultrasound. The tumour was intrahepatic in two patients, with signal hypointense in T1 W and hyperintense in T2 W. Diffusion was restricted. The lesions showed heterogeneous contrast-enhancement. The periductal lesions were hypointense in T1 W, hyperintense in T2 W with restricted diffusion. The lesion showed progressive contrast-enhancement. Peribiliary melanoma was hyperintense in T1 W, hyperintense in T2 W with restricted diffusion and progressively contrast-enhanced. CONCLUSION Biliary tumours can have a wide spectrum of radiologic appearances and consequently represent a diagnostic challenge for the radiologist. Advances in knowledge: MRI is the technique of choice in diagnosing biliary tumours, including rare (non-CCC) tumours.
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Affiliation(s)
- Vincenza Granata
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Roberta Fusco
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Orlando Catalano
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Salvatore Filice
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Antonio Avallone
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Mauro Piccirillo
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Maddalena Leongito
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Raffaele Palaia
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Roberto Grassi
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Francesco Izzo
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Antonella Petrillo
- 1 Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napol, Naples, Italy.,2 Division of Abdominal Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.,3 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, NaplesI, Italy.,4 Division of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
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Abstract
Cholangiocarcinoma is the second most common primary malignant hepatobiliary neoplasm, accounting for approximately 15% of liver cancers. Diagnosis of cholangiocarcinoma is challenging and the prognosis is uniformly poor, with recurrence rates of 60%-90% after surgical resection. A wide spectrum of neoplastic and nonneoplastic conditions of the biliary tract may masquerade as cholangiocarcinoma, adding to the complexity of management in patients suspected to have cholangiocarcinoma. Mimics of cholangiocarcinoma constitute a heterogeneous group of entities that includes primary sclerosing cholangitis, recurrent pyogenic cholangitis, acquired immunodeficiency syndrome cholangiopathy, autoimmune pancreatitis, inflammatory pseudotumor, Mirizzi syndrome, xanthogranulomatous cholangitis, sarcoidosis, chemotherapy-induced sclerosis, hepatocellular carcinoma, metastases, melanoma, lymphoma, leukemia, and carcinoid tumors. These entities demonstrate characteristic histomorphology and variable clinicobiologic behaviors. The imaging findings of these disparate entities are protean and may be indistinguishable from those of cholangiocarcinoma. In most cases, a definitive diagnosis can be established only with histopathologic examination of a biopsy specimen.
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Affiliation(s)
- Christine O Menias
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA
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