AIM:To explore the characteristics of multi-slice computed tomography(CT)manifestations of hepatic epithelioid angiomyolipoma(HEA),improve the rate of accurate diagnosis,and reduce the misdiagnostic rate.METHODS:The m...AIM:To explore the characteristics of multi-slice computed tomography(CT)manifestations of hepatic epithelioid angiomyolipoma(HEA),improve the rate of accurate diagnosis,and reduce the misdiagnostic rate.METHODS:The multi-slice CT manifestations in five patients who were diagnosed with HEA definitely by postoperative pathological examination were analysed retrospectively.Three female patients and two male patients were included.Before operation,four patients received plain CT scanning and dynamic enhancement scanning,and the other patient only received enhancement scanning,with immunohistochemical analysis conducted after postoperative pathological examination.Four patients were misdiagnosed by CT,including three patients misdiagnosed with hepatic cell carcinoma and one patient with focal nodular hyperplasia.RESULTS:Upper abdominal multi-slice spiral CT scanning and three-stage enhancement scanning were conducted in five patients with HEA before operation.HEA had certain characteristic CT manifestations:low density masses,a few relatively high-density masses or fatdensity masses diffusely shown in foci,clear boundary,round or oval and large focus,and tumour size ranging from 3.1 cm×2.5 cm to 7.0 cm×5.2 cm.During enhancement scanning,the foci were significantly enhanced uniformly or non-uniformly during the arterial phase,while during the venous and equilibrium phases,the foci were enhanced continuously or showed obvious low-density masses.Obviously enhanced and widened vessels could be found adjacent to foci or in the central area of foci during the arterial phase.CONCLUSION:CT manifestations of HEA have certain characteristics.Primary diagnosis can be obtained by combining CT findings with clinical data,but pathological examination is still needed for a definite diagnosis.展开更多
BACKGROUND Hepatic epithelioid angiomyolipoma(HEA)has a low incidence and both clinical manifestations and imaging lack specificity.Thus,it is easy to misdiagnose HEA as other tumors of the liver,especially in the pre...BACKGROUND Hepatic epithelioid angiomyolipoma(HEA)has a low incidence and both clinical manifestations and imaging lack specificity.Thus,it is easy to misdiagnose HEA as other tumors of the liver,especially in the presence of liver diseases such as hepatitis cirrhosis.This article reviewed the diagnosis and treatment of a patient with HEA and alcoholic cirrhosis,and analyzed the literature,in order to improve the understanding of this disease.CASE SUMMARY A 67-year-old male patient with a history of alcoholic cirrhosis was admitted due to the discovery of a space-occupying lesion in the liver.Based on the patient’s history,laboratory examinations,and imaging examinations,a malignant liver tumor was considered and laparoscopic partial hepatectomy was performed.Postoperative pathology showed HEA.During outpatient follow-up,the patient showed no sign of recurrence.CONCLUSION HEA is difficult to make a definite diagnosis before surgery.HEA has the poten-tial for malignant degeneration.If conditions permit,surgical treatment is recom-mended.展开更多
AIM:To retrospectively evaluate the computed tomography(CT)/magnetic resonance imaging(MRI) imaging features of epithelioid angiomyolipoma of the liver(Epi-HAML),with pathology as a reference. METHODS:The CT/MRI findi...AIM:To retrospectively evaluate the computed tomography(CT)/magnetic resonance imaging(MRI) imaging features of epithelioid angiomyolipoma of the liver(Epi-HAML),with pathology as a reference. METHODS:The CT/MRI findings(number,diameter, lobar location,and appearance of lesions)in a series of 10 patients with 12 pathologically proven epithelioid angiomyolipomas of the liver were retrospectively analyzed.The imaging features,including attenuation/ signal intensity characteristics,presence of fat, hypervascular,outer rim,and vessels within lesion, were evaluated and compared with that of non-Epi-HAML in 11 patients(13 lesions).The Fisher exact test was used to compare difference in probability of imaging features between the two types. RESULTS:For 21 patients,CT images of 15 patients and MR images of six patients were available.No patient underwent two examinations.For the 15 patients with a CT scan,all HAML lesions in the two groups(10 Epi-HAML and seven non-Epi-HAML) manifested as hypoattenuation.For the six patients with MRI,all lesions(two Epi-HAML and six non-Epi- HAML)were hypointense on T1WI(fat suppression)and hyperintense on T2WI.There were 10 non-Epi-HAML, but only two Epi-HAML lesions showed the presence offat,which significantly different between the two types (P=0.005).On the dynamic contrast enhancement (DCE)imaging,eight Epi-HAML,and 13 non-Epi lesions manifested as hypervascular.Punctate or curved vessels were displayed in 10 Epi-HAML as well as in nine non-Epi lesions and outer rim enhancement could be found with eight Epi-HAML as well as six non-Epi lesions. CONCLUSION:Little or no presence of adipose tissue was found to be an imaging feature of Epi-HAML,compared with the non-Epi type.In addition, hypervascularity with opacification of central punctiform or filiform vessels on DCE would be a characteristic enhancement pattern for Epi-HAML.展开更多
BACKGROUND Angiomyolipomas(AMLs),belonging to the family of mesenchymal tumors,are considered benign lesions that occur mostly in the kidney or as a part of tuberous sclerosis.Epithelioid AML(EAML)is a rare type of AM...BACKGROUND Angiomyolipomas(AMLs),belonging to the family of mesenchymal tumors,are considered benign lesions that occur mostly in the kidney or as a part of tuberous sclerosis.Epithelioid AML(EAML)is a rare type of AML that appears to have malignant potential.Extrarenal AMLs usually occur in the liver according to the retrieved literature reports.There have been only two previous reports of monofocal primary AML of the pancreas;however,no cases of primary monotypic EAML of the pancreas have been reported.CASE SUMMARY An asymptomatic 59-year-old woman incidentally revealed a tumor during abdominal ultrasound examination.Routine blood tests and physical examination were within normal limits.Abdominal ultrasound revealed a 1.9-cm hypoechogenic mass in the tail of the pancreas,clearly visualized by endoscopic ultrasound.However,contrast-enhanced abdominal computed tomography scans did not demonstrate the lesion.A subsequent gadolinium-enhanced magnetic resonance imaging scan showed that the lesion had some characteristic manifestations.The lesion was initially thought to be a neuroendocrine tumor(asymptomatic PanNET).After surgical resection,histopathology and immunohistochemistry confirmed the diagnosis of EAML.At the 6-mo follow-up,no recurrence,spread,or metastasis was identified on computed tomography or magnetic resonance imaging.CONCLUSION The preoperative diagnosis of pancreatic AML is extremely difficult.Imaging techniques are essential for providing valuable morphological features for differential diagnosis.展开更多
BACKGROUND: Hepatic epithelioid hemangioendothelioma (EHE) is a rare, low-grade malignant vascular tumor. Although its unusual imaging and pathologic findings are being recognized with increasing frequency, diagnosis ...BACKGROUND: Hepatic epithelioid hemangioendothelioma (EHE) is a rare, low-grade malignant vascular tumor. Although its unusual imaging and pathologic findings are being recognized with increasing frequency, diagnosis is still difficult. This study aimed to analyze the CT and MRI features of hepatic EHE with a pathological study in order to improve the diagnostic accuracy and knowledge of this disease in daily practice. METHODS: Nine patients with hepatic EHE confirmed pathologically underwent plain and dynamic contrast-enhanced multi-detector row CT examination. Of these patients, four underwent additional MRI (plain Ti-weighted imaging (T1WI), T2-weighted imaging (T2WI), and dynamic contrast-enhanced scanning) and one had selective hepatic arteriography. The imaging findings were reviewed retrospectively together with the pathological results. RESULTS: A total of 79 lesions, ranging from 3.0 to 44.6 mm in maximum diameter, with an average of 16.8 +/- 7.1 mm, were found in various segments of the liver. Thirty of the 79 lesions grew adjacent to the hepatic capsule. In the 4 patients receiving MRI, 39 lesions were found with low signal intensity on unenhanced T1WI and intermediate to high signal intensity on T2WI. The 'capsular retraction' sign was found in all the 4 patients. Nine of the 39 lesions showed the 'halo' sign after contrast enhancement on MRI. Of the 79 lesions (hypodense nodules) in the 9 patients shown by unenhanced plain CT, 26 were confluent. Calcification was found in 2 patients and the 'capsular retraction' sign in 7. Thirty-eight of the 79 lesions demonstrated the 'halo' sign after contrast enhancement on CT, and this sign was more clearly demonstrated in the portal venous phase. In one patient, selective hepatic arteriography showed patchy stain in the peripheral liver parenchyma with small vessels around them. Histology in all patients revealed proliferation of abnormal fibrous tissue and vessel-like structures scattered with irregular epithelioid cells having a signet ring-like structure. Immunohistochemically, all patients were positive for CD34, 4 were positive for CD31, and 3 were positive for factor VIII-related antigen. CONCLUSIONS: Hepatic EHE may manifest as solitary or diffuse nodular lesions with a predilection for peripheral subcapsular growth and nodular confluence, together with the 'halo' and 'capsular retraction' signs. These imaging findings can help to improve the diagnostic accuracy of this rare hepatic tumor. (Hepatobiliary Pancreat Dis Int 2010; 9: 154-158)展开更多
AIM:To investigate and review the contrast-enhanced multiple-phase computed tomography(CEMP CT)and magnetic resonance imaging(MRI)findings in patients with pathologically confirmed hepatic epithelioid hemangioendothel...AIM:To investigate and review the contrast-enhanced multiple-phase computed tomography(CEMP CT)and magnetic resonance imaging(MRI)findings in patients with pathologically confirmed hepatic epithelioid hemangioendothelioma(HEHE).METHODS:Findings from imaging examinations in 8 patients(5 women and 3 men)with pathologically confirmed HEHE were retrospectively reviewed(CT images obtained from 7 patients and MR images obtained from 6 patients).The age of presentation varied from 27 years to 60 years(average age 39.8 years).RESULTS:There were two types of HEHE:multifocal type(n=7)and diffuse type(n=1).In the multifocal-type cases,there were 74 lesions on CT and 28 lesions on MRI with 7 lesions found with diffusion weighted imaging;18(24.3%)of 74 lesions on plainCT and 26(92.9%)of 28 lesions on pre-contrast MRI showed the target sign.On CEMP CT,28(37.8%) of 74 lesions appeared with the target sign and a progressive-enhancement rim and 9(12.2%)of 74 lesions displayed progressive enhancement,maintaining a state of persistent enhancement.On CEMP MRI,27(96.4%)of 28 lesions appeared with the target sign with a progressive-enhancement rim and 28(100%) of 28 lesions displayed progressive-enhancement,maintaining a state of persistent enhancement.In the diffuse-type cases,an enlarged liver was observed with a large nodule appearing with persistent enhancement on CEMP CT and MRI.CONCLUSION:The most important imaging features of HEHE are the target sign and/or progressive enhancement with persistent enhancement on CEMP CT and MRI.MRI is advantageous over CT in displaying these imaging features.展开更多
Tuberous sclerosis complex (TSC) is a dominantly inherited disorder which characterized by the growth of harmatomatous in multiple organs. Unlike the common development of renal angiomyolipoma, hepatic angiomyolipoma ...Tuberous sclerosis complex (TSC) is a dominantly inherited disorder which characterized by the growth of harmatomatous in multiple organs. Unlike the common development of renal angiomyolipoma, hepatic angiomyolipoma rarely occur in patients with TSC. We report here a patient with hepatic angiomyolipomas and concurrent hepatocellular carcinoma in TSC. This represents the first reported case in English literature. In this patient, multiple hepatic angiomyolipomas were diagnosed with recognition of their fat components and typical clinical settings. Hepatocellular carcinoma in the left liver lobe was definitely diagnosed by US guided biopsy. In such clinical settings, fat containing lesions in liver can be reasonably treated as angiomyolipomas, but non fat containing lesions must be differentiated from hepatocellular carcinoma, imaging guided biopsy can be adopted to confirm the diagnosis.展开更多
基金Supported by Jilin Provincial Science and Technology Department,No.201015158 and No.20110922Jilin Provincial Administration of Traditional Chinese Medicine,No.2011-JS20
文摘AIM:To explore the characteristics of multi-slice computed tomography(CT)manifestations of hepatic epithelioid angiomyolipoma(HEA),improve the rate of accurate diagnosis,and reduce the misdiagnostic rate.METHODS:The multi-slice CT manifestations in five patients who were diagnosed with HEA definitely by postoperative pathological examination were analysed retrospectively.Three female patients and two male patients were included.Before operation,four patients received plain CT scanning and dynamic enhancement scanning,and the other patient only received enhancement scanning,with immunohistochemical analysis conducted after postoperative pathological examination.Four patients were misdiagnosed by CT,including three patients misdiagnosed with hepatic cell carcinoma and one patient with focal nodular hyperplasia.RESULTS:Upper abdominal multi-slice spiral CT scanning and three-stage enhancement scanning were conducted in five patients with HEA before operation.HEA had certain characteristic CT manifestations:low density masses,a few relatively high-density masses or fatdensity masses diffusely shown in foci,clear boundary,round or oval and large focus,and tumour size ranging from 3.1 cm×2.5 cm to 7.0 cm×5.2 cm.During enhancement scanning,the foci were significantly enhanced uniformly or non-uniformly during the arterial phase,while during the venous and equilibrium phases,the foci were enhanced continuously or showed obvious low-density masses.Obviously enhanced and widened vessels could be found adjacent to foci or in the central area of foci during the arterial phase.CONCLUSION:CT manifestations of HEA have certain characteristics.Primary diagnosis can be obtained by combining CT findings with clinical data,but pathological examination is still needed for a definite diagnosis.
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY19H030004and The Lishui City Key Research and Ddevelopment Project,No.2022ZDYF08。
文摘BACKGROUND Hepatic epithelioid angiomyolipoma(HEA)has a low incidence and both clinical manifestations and imaging lack specificity.Thus,it is easy to misdiagnose HEA as other tumors of the liver,especially in the presence of liver diseases such as hepatitis cirrhosis.This article reviewed the diagnosis and treatment of a patient with HEA and alcoholic cirrhosis,and analyzed the literature,in order to improve the understanding of this disease.CASE SUMMARY A 67-year-old male patient with a history of alcoholic cirrhosis was admitted due to the discovery of a space-occupying lesion in the liver.Based on the patient’s history,laboratory examinations,and imaging examinations,a malignant liver tumor was considered and laparoscopic partial hepatectomy was performed.Postoperative pathology showed HEA.During outpatient follow-up,the patient showed no sign of recurrence.CONCLUSION HEA is difficult to make a definite diagnosis before surgery.HEA has the poten-tial for malignant degeneration.If conditions permit,surgical treatment is recom-mended.
文摘AIM:To retrospectively evaluate the computed tomography(CT)/magnetic resonance imaging(MRI) imaging features of epithelioid angiomyolipoma of the liver(Epi-HAML),with pathology as a reference. METHODS:The CT/MRI findings(number,diameter, lobar location,and appearance of lesions)in a series of 10 patients with 12 pathologically proven epithelioid angiomyolipomas of the liver were retrospectively analyzed.The imaging features,including attenuation/ signal intensity characteristics,presence of fat, hypervascular,outer rim,and vessels within lesion, were evaluated and compared with that of non-Epi-HAML in 11 patients(13 lesions).The Fisher exact test was used to compare difference in probability of imaging features between the two types. RESULTS:For 21 patients,CT images of 15 patients and MR images of six patients were available.No patient underwent two examinations.For the 15 patients with a CT scan,all HAML lesions in the two groups(10 Epi-HAML and seven non-Epi-HAML) manifested as hypoattenuation.For the six patients with MRI,all lesions(two Epi-HAML and six non-Epi- HAML)were hypointense on T1WI(fat suppression)and hyperintense on T2WI.There were 10 non-Epi-HAML, but only two Epi-HAML lesions showed the presence offat,which significantly different between the two types (P=0.005).On the dynamic contrast enhancement (DCE)imaging,eight Epi-HAML,and 13 non-Epi lesions manifested as hypervascular.Punctate or curved vessels were displayed in 10 Epi-HAML as well as in nine non-Epi lesions and outer rim enhancement could be found with eight Epi-HAML as well as six non-Epi lesions. CONCLUSION:Little or no presence of adipose tissue was found to be an imaging feature of Epi-HAML,compared with the non-Epi type.In addition, hypervascularity with opacification of central punctiform or filiform vessels on DCE would be a characteristic enhancement pattern for Epi-HAML.
文摘BACKGROUND Angiomyolipomas(AMLs),belonging to the family of mesenchymal tumors,are considered benign lesions that occur mostly in the kidney or as a part of tuberous sclerosis.Epithelioid AML(EAML)is a rare type of AML that appears to have malignant potential.Extrarenal AMLs usually occur in the liver according to the retrieved literature reports.There have been only two previous reports of monofocal primary AML of the pancreas;however,no cases of primary monotypic EAML of the pancreas have been reported.CASE SUMMARY An asymptomatic 59-year-old woman incidentally revealed a tumor during abdominal ultrasound examination.Routine blood tests and physical examination were within normal limits.Abdominal ultrasound revealed a 1.9-cm hypoechogenic mass in the tail of the pancreas,clearly visualized by endoscopic ultrasound.However,contrast-enhanced abdominal computed tomography scans did not demonstrate the lesion.A subsequent gadolinium-enhanced magnetic resonance imaging scan showed that the lesion had some characteristic manifestations.The lesion was initially thought to be a neuroendocrine tumor(asymptomatic PanNET).After surgical resection,histopathology and immunohistochemistry confirmed the diagnosis of EAML.At the 6-mo follow-up,no recurrence,spread,or metastasis was identified on computed tomography or magnetic resonance imaging.CONCLUSION The preoperative diagnosis of pancreatic AML is extremely difficult.Imaging techniques are essential for providing valuable morphological features for differential diagnosis.
文摘BACKGROUND: Hepatic epithelioid hemangioendothelioma (EHE) is a rare, low-grade malignant vascular tumor. Although its unusual imaging and pathologic findings are being recognized with increasing frequency, diagnosis is still difficult. This study aimed to analyze the CT and MRI features of hepatic EHE with a pathological study in order to improve the diagnostic accuracy and knowledge of this disease in daily practice. METHODS: Nine patients with hepatic EHE confirmed pathologically underwent plain and dynamic contrast-enhanced multi-detector row CT examination. Of these patients, four underwent additional MRI (plain Ti-weighted imaging (T1WI), T2-weighted imaging (T2WI), and dynamic contrast-enhanced scanning) and one had selective hepatic arteriography. The imaging findings were reviewed retrospectively together with the pathological results. RESULTS: A total of 79 lesions, ranging from 3.0 to 44.6 mm in maximum diameter, with an average of 16.8 +/- 7.1 mm, were found in various segments of the liver. Thirty of the 79 lesions grew adjacent to the hepatic capsule. In the 4 patients receiving MRI, 39 lesions were found with low signal intensity on unenhanced T1WI and intermediate to high signal intensity on T2WI. The 'capsular retraction' sign was found in all the 4 patients. Nine of the 39 lesions showed the 'halo' sign after contrast enhancement on MRI. Of the 79 lesions (hypodense nodules) in the 9 patients shown by unenhanced plain CT, 26 were confluent. Calcification was found in 2 patients and the 'capsular retraction' sign in 7. Thirty-eight of the 79 lesions demonstrated the 'halo' sign after contrast enhancement on CT, and this sign was more clearly demonstrated in the portal venous phase. In one patient, selective hepatic arteriography showed patchy stain in the peripheral liver parenchyma with small vessels around them. Histology in all patients revealed proliferation of abnormal fibrous tissue and vessel-like structures scattered with irregular epithelioid cells having a signet ring-like structure. Immunohistochemically, all patients were positive for CD34, 4 were positive for CD31, and 3 were positive for factor VIII-related antigen. CONCLUSIONS: Hepatic EHE may manifest as solitary or diffuse nodular lesions with a predilection for peripheral subcapsular growth and nodular confluence, together with the 'halo' and 'capsular retraction' signs. These imaging findings can help to improve the diagnostic accuracy of this rare hepatic tumor. (Hepatobiliary Pancreat Dis Int 2010; 9: 154-158)
文摘AIM:To investigate and review the contrast-enhanced multiple-phase computed tomography(CEMP CT)and magnetic resonance imaging(MRI)findings in patients with pathologically confirmed hepatic epithelioid hemangioendothelioma(HEHE).METHODS:Findings from imaging examinations in 8 patients(5 women and 3 men)with pathologically confirmed HEHE were retrospectively reviewed(CT images obtained from 7 patients and MR images obtained from 6 patients).The age of presentation varied from 27 years to 60 years(average age 39.8 years).RESULTS:There were two types of HEHE:multifocal type(n=7)and diffuse type(n=1).In the multifocal-type cases,there were 74 lesions on CT and 28 lesions on MRI with 7 lesions found with diffusion weighted imaging;18(24.3%)of 74 lesions on plainCT and 26(92.9%)of 28 lesions on pre-contrast MRI showed the target sign.On CEMP CT,28(37.8%) of 74 lesions appeared with the target sign and a progressive-enhancement rim and 9(12.2%)of 74 lesions displayed progressive enhancement,maintaining a state of persistent enhancement.On CEMP MRI,27(96.4%)of 28 lesions appeared with the target sign with a progressive-enhancement rim and 28(100%) of 28 lesions displayed progressive-enhancement,maintaining a state of persistent enhancement.In the diffuse-type cases,an enlarged liver was observed with a large nodule appearing with persistent enhancement on CEMP CT and MRI.CONCLUSION:The most important imaging features of HEHE are the target sign and/or progressive enhancement with persistent enhancement on CEMP CT and MRI.MRI is advantageous over CT in displaying these imaging features.
文摘Tuberous sclerosis complex (TSC) is a dominantly inherited disorder which characterized by the growth of harmatomatous in multiple organs. Unlike the common development of renal angiomyolipoma, hepatic angiomyolipoma rarely occur in patients with TSC. We report here a patient with hepatic angiomyolipomas and concurrent hepatocellular carcinoma in TSC. This represents the first reported case in English literature. In this patient, multiple hepatic angiomyolipomas were diagnosed with recognition of their fat components and typical clinical settings. Hepatocellular carcinoma in the left liver lobe was definitely diagnosed by US guided biopsy. In such clinical settings, fat containing lesions in liver can be reasonably treated as angiomyolipomas, but non fat containing lesions must be differentiated from hepatocellular carcinoma, imaging guided biopsy can be adopted to confirm the diagnosis.
