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Advanced Ultrasound in Diagnosis and Therapy ›› 2022, Vol. 6 ›› Issue (4): 204-209.doi: 10.37015/AUDT.2022.220014

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  • 收稿日期:2022-03-24 修回日期:2022-04-14 接受日期:2022-04-24 出版日期:2022-12-30 发布日期:2022-10-25

Contrast-enhanced Ultrasound of Undifferentiated Embryonal Sarcoma of the Liver in Adult: Two Cases Report and Literature Review

Yanling Chen, MMa, Hantao Wang, MMa,b, Hong Han, PhDa,b, Yi Dong, PhDa,b, Wen-ping Wang, MDa,b,c,*()   

  1. a Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
    b Shanghai Institute of Medical Imaging, Shanghai, China
    c Institute of Ultrasound Medicine and Engineering, Fudan University, Shanghai, China
  • Received:2022-03-24 Revised:2022-04-14 Accepted:2022-04-24 Online:2022-12-30 Published:2022-10-25
  • Contact: Wen-ping Wang, MD E-mail:puguang61@126.com

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Abstract:

Undifferentiated embryonal sarcoma of the liver (UESL) is an aggressive mesenchymal tumor, which presents a low incidence in adults. The low morbidity and atypical clinical manifestations conduce to difficulty in preoperative diagnosis. Imaging manifestations of this tumor is important for its identification. Contrast-enhanced ultrasound (CEUS) was a promising tool to characterize hepatic lesions and proved to have high diagnostic accuracy. The present study reported the CEUS characteristics of UESL in two adult patients, which exhibited peripheral rim hyper-enhancement along with progressively centripetal enhancement and large areas of perfusion defection. Sonographers should be fully aware of this rare disease for better differential diagnosis.

Key words: Contrast-enhanced ultrasound, Undifferentiated embryonal sarcoma of the liver, Diagnosis, Case report

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Liver neoplasms Symptoms Laboratory test/tumor markers B-mode ultrasound Contrast-enhanced ultrasound
Arterial phase Portal venous phase Late phase
Undifferentiated embryonal sarcoma of the liver Abdominal mass, abdominal pain, fever, nausea, weight lost, et al. Normal /TBL, ALT, AST, AKP, γ-GGT, et al. A heterogeneous echogenic cystic-solid mass with well-defined boundary and irregular shape; Maximum diameter more than 10 cm Peripheral rim hyperenhancement along with progressively centripetal enhancement; Large areas of perfusion defection within the lesion Iso-enhancement or sightly hypo-enhancement Iso-enhancement or sightly hypo-enhancement
Liver abscess Abdominal pain, hyperthermia, chills, nausea, vomiting, et al. WBC; ESR; CRP A cystic mass with honeycomb-like necrotic areas Rim enhancement; No enhancement or honeycomb-like enhancement in the center The ring-enhancing part gradually become hypo-enhancement Slightly hypo-enhancement
Intrahepatic cholangiocarcinoma Abdominal mass, abdominal pain, fatigue, weakness, jaundice, weight lost, et al. CA19-9; AFP; TBL, ALT, AST, AKP, γ-GGT, et al. Hypoechoic, isoechoic, or hyperechoic mass with ill-defined boundary and irregular shape; Biliary ductal dilatation; Metastasis; Vascular invasion Rim-like enhancement; Heterogeneous hyperenhancement; Homogeneous hyperenhancement Significant hypo-enhancement Non-enhancement
Hemangiosarcoma Abdominal pain, fever, anorexia, fatigue, weight loss, et al. Normal Hypoechoic mass with ill-defined boundary Nodular peripheral enhancement or peripheral rim-like enhancement; Central non-enhancement Peripheral enhancement declined gradually Hypo-enhancement
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