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Bahador A, Forooghi M, Shahriarirad R, Geramizadeh B, Ataollahi M, Kamran H. A large undifferentiated sarcoma of the liver in a 13-year-old girl treated with anatomical resection: a case report and review of the literature. BMC Gastroenterol 2022; 22:2. [PMID: 34979950 PMCID: PMC8722022 DOI: 10.1186/s12876-021-02076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Undifferentiated embryonal sarcoma of the liver (UESL) is a rare liver tumor accounting for 6–13% of primary liver tumors. Accurate preoperative diagnosis is difficult, with a rather high misdiagnosis rate. Herein, we reported a very large UESL treated with anatomical resection. Our case is amongst the largest pediatric UESLs in the literature. Case presentation Herein, we report a 13-year-old girl presenting with right upper quadrant abdominal pain, postprandial vomiting, and abdominal distention, in which radiographic imaging demonstrated a huge UESL (28 × 20 × 12 cm). The patient was treated with partial hepatectomy and the 5 kg tumor was removed. The patient was discharged in good condition, with no significant complaints in her follow-up. Conclusions Although different treatment strategies have been reported for UESL cases, anatomical resection is still the main treatment approach, especially for large tumors.
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Affiliation(s)
- Ali Bahador
- Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Forooghi
- Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ataollahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. .,Nemazee Hospital, Zand Street, Nemazee Square, 71936-13311, Shiraz, Iran.
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Jiang Y, Chen F, LeGout J, Alexander L, Stauffer J, Metcalfe A. Undifferentiated embryonal sarcoma of the liver presenting as a hemorrhagic mass in a pregnant woman. Clin Imaging 2021; 77:58-61. [PMID: 33640792 DOI: 10.1016/j.clinimag.2021.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/06/2021] [Accepted: 02/21/2021] [Indexed: 12/15/2022]
Abstract
We present a case of undifferentiated embryonal sarcoma of the liver (UES), an uncommon malignant mesenchymal tumor that occurs predominately in children and is very rarely seen in adults. Our patient is a 32-year-old pregnant female without significant past medical history, who presented to the emergency department with worsening abdominal pain and a large palpable abdominal mass. Imaging identified a large, hemorrhagic right hepatic lobe mass that in retrospect had imaging characteristics most suggestive of UES. Though extremely rare in adults, it is still important to recognize the imaging features of UES as to avoid mistaking it for other more common benign and malignant hepatic masses.
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Affiliation(s)
- Yang Jiang
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Frank Chen
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America.
| | - Jordan LeGout
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Lauren Alexander
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America
| | - John Stauffer
- Department of General Surgery, Mayo Clinic, Jacksonville, FL, United States of America
| | - Allie Metcalfe
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America
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Gomes F, Melo D, Esteves C, Lima B, Carneiro F, Oliveira P. Undifferentiated embryonal sarcoma of the liver: A rare hepatic tumor and its related characteristic radiological features. Radiol Case Rep 2021; 16:646-650. [PMID: 33488891 PMCID: PMC7806539 DOI: 10.1016/j.radcr.2020.12.017] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 12/31/2022] Open
Abstract
The undifferentiated embryonal sarcoma of the liver is a rare tumor with a poor prognosis, with improved outcomes being reported with more recently multimodality treatments. We report a case of a 6-year-old girl with an incidentally diagnosed and histologically proven localized undifferentiated embryonal sarcoma of the liver. The divergence between solid appearance at US and cystic-like appearance on CT/MRI, which has been attributed to the presence of myxoid component frequently described with this tumor, was crucial for the diagnosis and subsequent treatment.
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Affiliation(s)
- Fernanda Gomes
- Radiology Department, Hospital de Braga, Sete Fontes - São Victor, 4710-243 Braga, Portugal
- Corresponding author.
| | - Daniel Melo
- Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Cátia Esteves
- Radiology Department, Hospital de Braga, Sete Fontes - São Victor, 4710-243 Braga, Portugal
| | - Beatriz Lima
- Radiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319 Portugal
| | - Fátima Carneiro
- Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Pedro Oliveira
- Radiology Department, Hospital de Braga, Sete Fontes - São Victor, 4710-243 Braga, Portugal
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Esteban SMG, Emilio CGU, Emmanuel ABF, Oscar SJ, Paulina CE, Angel MM. Undifferentiated embryonal sarcoma of the liver in adult patient: A report of two cases. Ann Hepatobiliary Pancreat Surg 2018; 22:269-273. [PMID: 30215049 PMCID: PMC6125275 DOI: 10.14701/ahbps.2018.22.3.269] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/10/2018] [Accepted: 02/16/2018] [Indexed: 01/06/2023] Open
Abstract
Primary sarcomas of the liver are unusual neoplasms developing in adults. They constitute a heterogeneous group of neoplasms including undifferentiated embryonal sarcoma. Patients usually present with an abdominal mass and abdominal pain. Case 1: A 53-year-old woman presented with abdominal pain. Computed tomography showed an occupying mass in the right lobule and an intra-auricular multi-lobulated mass suggestive of a secondary deposit. Biopsy of the hepatic lesion revealed undifferentiated embryonal sarcoma. Despite radiotherapy and supportive measures, her overall status progressively worsened until cardiac arrest. Case 2: A 41-year-old woman presented with hepatomegaly. Abdominal imaging showed cystic lesions in the right hepatic lobule with multiple septae. The patient underwent extended right hepatectomy and a histopathological study reported high-grade undifferentiated embryonal sarcoma. Two years after surgery, a new cystic lesion in the surgical site was recorded and chemotherapy was scheduled. The lesion remained stable for three years when disease progression was observed and second-line chemotherapy was initiated. Although undifferentiated embryonal sarcoma of the liver has poor prognosis, early diagnosis is essential to increase the chances of survival. Currently, surgical resection and chemotherapy are the primary treatment modalities.
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Affiliation(s)
| | | | | | - Santes-Jasso Oscar
- Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carpinteyro-Espin Paulina
- Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mercado Miguel Angel
- Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Masuda T, Beppu T, Doi K, Miyata T, Nakagawa S, Okabe H, Hayashi H, Ishiko T, Iyama KI, Baba H. Repeated hepatic resections and radio-frequency ablations may improve the survival of adult undifferentiated embryonal sarcoma of the liver: report of two cases. Surg Case Rep 2015; 1:55. [PMID: 26366352 PMCID: PMC4560125 DOI: 10.1186/s40792-015-0056-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 06/10/2015] [Indexed: 01/08/2023] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) in adults, especially over 30 years old, is quite rare. We report two adult UESL patients that one of them survived 62 months and one is now surviving more than 65 months treated with repeated hepatic resections and radio-frequency ablations. Although UESL is an entirely unusual and aggressive tumor, multidisciplinary treatments including repeated hepatic resections and radio-frequency ablations may provide a longer survival.
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Affiliation(s)
- Toshiro Masuda
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan
| | - Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan ; Department of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto, Japan
| | - Koichi Doi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan
| | - Takatoshi Ishiko
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan
| | - Ken-Ichi Iyama
- Department of Surgical Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811 Japan
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Mathews J, Duncavage EJ, Pfeifer JD. Characterization of translocations in mesenchymal hamartoma and undifferentiated embryonal sarcoma of the liver. Exp Mol Pathol 2013; 95:319-24. [PMID: 24120702 DOI: 10.1016/j.yexmp.2013.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 09/27/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Mesenchymal hamartoma of the liver (MHL) is an uncommon benign primary liver tumor that typically occurs in the pediatric population, although cases have been described in adults. MHL is sometimes associated with the highly malignant undifferentiated embryonal sarcoma (UES), and the synchronous or metachronous occurrence of MHL and UES suggests they share a common genetic link. Although the exact mechanism of tumorigenesis has not been identified, MHL cases harbor recurring chromosomal rearrangements involving 19q13. DESIGN In order to provide more details on the genetic events of MHL tumorigenesis, capture-based next generation sequencing (NGS) targeted to loci recently shown to be involved in a translocation in a case of UES arising in MHL (specifically, the MALAT1 gene on chromosome 11 and a gene poor region termed MHLB1 on chromosome 19) was performed on formalin fixed paraffin embedded tissue from seven cases of MHL. RESULTS Chromosome rearrangements involving the MHLB1 locus were identified in three of the seven cases, including the translocation t(11,19)(q13.1;q13.42) involving the MALAT1 gene; the translocation t(2,19)(q31.1;q13.42) involving AK023515, an uncharacterized noncoding gene; and the inversion inv(19,19)(q13.42;q13.43) involving the PEG3 gene encoding a Kruppel-type zinc-finger protein. Rearrangements were exclusively identified in pediatric tumors. In each case, the presence of the rearrangement was confirmed by PCR and interphase FISH. Interphase FISH also demonstrated that the arrangements occur within the spindle cell component but not within the epithelial components of the tumor. CONCLUSIONS Since the MHLB1 locus contains a CpG-rich region whose methylation regulates C19MC miRNA genes, rearrangements that disrupt this region may contribute to MHL development through alteration of miRNA expression. The demonstration that the loose stromal cells harbor the rearrangements indicates that (some cases of) MHL are a neoplastic process due to a somatic genetic change and not a germline abnormality.
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Affiliation(s)
- James Mathews
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology, Washington University School of Medicine, St. Louis, MO, USA.
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Jia CJ, Zhao W, Dai CL. Diagnosis and treatment of undifferentiated embryonal sarcoma of the liver: A retrospective study of four cases. Shijie Huaren Xiaohua Zazhi 2013; 21:1327-1332. [DOI: 10.11569/wcjd.v21.i14.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the diagnosis and treatment of undifferentiated embryonal sarcoma of the liver (UESL).
METHODS: Clinical data for four patients with pathologically confirmed UESL who were treated at our hospital between 2005 and 2011 were retrospectively analyzed.
RESULTS: Three children (2 female and 1 male) and one female adult were included. Their age was 14, 14, 6 and 46 years old, respectively. Clinical presentation was typically an abdominal mass that may be accompanied by pain and/or fever. Diagnosis relies on histopathological examination and it is difficult for radiological examination to establish a definite diagnosis. Tumors were removed surgically in all four patients, and two patients received adjuvant chemotherapy.
CONCLUSION: UESL is an unusua1 malignancy of the 1iver. Whenever feasible, radica1 resection should be attempted as a part of combination modalities. Multiagent adjuvant chemotherapy and supportive therapy might improve surviva1.
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Guo W, Chen Q, Yu YQ. Undifferentiated embryonal sarcoma of the liver in adult: a case report. Shijie Huaren Xiaohua Zazhi 2011; 19:2999-3001. [DOI: 10.11569/wcjd.v19.i28.2999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare disease that is easily misdiagnosed. Advances in diagnostic imaging and hepatic surgical technique have increased the detection rate of this disease. Here we report a case of UESL in adult and review the relevant literature focusing on the diagnosis and treatment of this rare disease.
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Li XW, Gong SJ, Song WH, Zhu JJ, Pan CH, Wu MC, Xu AM. Undifferentiated liver embryonal sarcoma in adults: A report of four cases and literature review. World J Gastroenterol 2010; 16:4725-32. [PMID: 20872975 PMCID: PMC2951525 DOI: 10.3748/wjg.v16.i37.4725] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the undifferentiated embryonal sarcoma of liver (UESL) in adults in order to improve its diagnosis and treatment.
METHODS: Four primary and one recurrent cases of UESL were clinicopathologically evaluated and immunohistochemically investigated with a panel of antibodies using the EnVision+ system. Relevant literature about UESL in adults was reviewed.
RESULTS: Three males and one female were enrolled in this study. Their chief complaints were abdominal pain, weight loss, or fever. Laboratory tests, imaging and pathological features of UESL in adults were similar to those in children. Immunohistochemistry showed evidence of widely divergent differentiation into mesenchymal and epithelial phenotypes. The survival time of patients who underwent complete tumor resection followed by adjuvant transcatheter arterial chemoembolization (TACE) was significantly longer than that of those who underwent surgical treatment alone.
CONCLUSION: UESL in adults may undergo pluripotential differentiation and its diagnosis should be made based on its morphological and immunohistochemical features. Complete tumor resection after adjuvant TACE may improve the survival time of such patients.
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