Advanced Ultrasound in Diagnosis and Therapy ›› 2022, Vol. 6 ›› Issue (4): 204-209.doi: 10.37015/AUDT.2022.220014
• Case Reports • Previous Articles Next Articles
Yanling Chen, MMa, Hantao Wang, MMa,b, Hong Han, PhDa,b, Yi Dong, PhDa,b, Wen-ping Wang, MDa,b,c,*()
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
Yanling Chen, MM, Hantao Wang, MM, Hong Han, PhD, Yi Dong, PhD, Wen-ping Wang, MD. Contrast-enhanced Ultrasound of Undifferentiated Embryonal Sarcoma of the Liver in Adult: Two Cases Report and Literature Review. Advanced Ultrasound in Diagnosis and Therapy, 2022, 6(4): 204-209.
Figure 1
Undifferentiated embryonal sarcoma of the liver (UESL) in a 76-year-old woman. (A) B-mode ultrasound (BMUS) showing a mixed echoic solid mass with irregular shape and relative clear boundary; (B-D) On contrast-enhanced ultrasound (CEUS), the nodule displayed rim hyperenhancement (arrows) followed by progressive centripetal fill-in (star) during the arterial phase, and gradually became hypo-enhancement in the portal venous and lated phase. Area of perfusion defection was observed; (E-F) On MRI, The nodule presented a irregular cystic appearance and showed hyperintensity on T2WI. Peripheral and progressive hyperenhancement were observed after contrast agent injection; (G-H) On histopathology, spindle-shaped cells and highly atypical cells were found within the tumor, accompanying by hemorrhage and necrosis (H&E staining; magnification: × 200). Immunohistochemical staining showed the tumor was positive for α-AT (magnification: × 200)."
Figure 2
Undifferentiated embryonal sarcoma of the liver (UESL) in a 46-year-old male. (A) The lesion appeared to be a heterogeneously echoic masses on sonography, with scatted anechoic areas; (B-D) On contrast-enhanced ultrasound (CEUS), it exhibited rim hyperenhancement and the enhancement progressed towarded the center during the arterial phase. Mild washout was observed in the portal venous and late phase. Perfusion defection scattered in the nodule during the whole scan; (E) The hypodense mass showed a multilocular cystic appearance. Progressive enhancement was observed in the sepatation within the tumor on contrast-enhanced CT; (F-G) The nodule exhibited delayed enhancement and the enhancement of the mass remained lower comparing with the surrounding parenchyma during the whole process on contrast-enhanced MRI; (H) PET/MRI showed 18F-fluorodeoxyglucose (FDG) uptake in part of the solid components of the cyst, with a maximum standardized uptake value (SUV) of 8.9; (I-J) Histopathological examination showed that the tumor cells were spindle or polygonal-shaped and in fascicular arrangement. (H&E staining; magnification: × 400). Immunohistochemistry analysis showed the tumor was positivity for vimentin (magnification: × 200)."
Table 1
Typical contrast-enhanced ultrasonography characteristics of the four liver lesions"
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 |
[1] |
Sy AM, Whitsett M, Li X, Theise ND, Dagher NN, Olsen S. Undifferentiated embryonal sarcoma of the liver: a great masquerade. J Gastrointest Cancer 2019, 50: 1043-1047.
doi: 10.1007/s12029-018-00194-6 |
[2] | Shu B, Gong L, Huang X, Cao L, Yan Z, Yang S. Undifferentiated embryonal sarcoma of the liver in adults: Retrospective analysis of a case series and systematic revie. Oncol Lett 2020, 20:102. |
[3] |
Wu Z, Wei Y, Cai Z, Zhou Y. Long-term survival outcomes of undifferentiated embryonal sarcoma of the liver: a pooled analysis of 308 patient. ANZ J Surg 2020, 90:1615-1620.
doi: 10.1111/ans.15684 |
[4] |
Walther A, Geller J, Coots A, Towbin A, Nathan J, Alonso M, et al. Multimodal therapy including liver transplantation for hepatic undifferentiated embryonal sarcom. Liver Transpl 2014, 20:191-199.
doi: 10.1002/lt.23773 |
[5] | Putra J, Ornvold K. Undifferentiated embryonal sarcoma of the liver: a concise revie. Archives of pathology & laboratory medicine 2015, 139:269-273. |
[6] | Wu M, Li L, Wang J, Zhang Y, Guo Q, Li X, et al. Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysi. Eur Radiol 2018, 28:2077-2088. |
[7] |
Mathews J, Duncavage EJ, Pfeifer JD. Characterization of translocations in mesenchymal hamartoma and undifferentiated embryonal sarcoma of the live. Exp Mol Pathol 2013, 95:319-324.
doi: 10.1016/j.yexmp.2013.09.006 pmid: 24120702 |
[8] |
Zhang C, Jia CJ, Xu C, Sheng QJ, Dou XG, Ding Y. Undifferentiated embryonal sarcoma of the liver: Clinical characteristics and outcome. World J Clin Cases 2020, 8:4763-4772.
doi: 10.12998/wjcc.v8.i20.4763 |
[9] |
Wei ZG, Tang LF, Chen ZM, Tang HF, Li MJ. Childhood undifferentiated embryonal liver sarcoma: clinical features and immunohistochemistry analysi. J Pediatr Surg 2008, 43:1912-1919.
doi: 10.1016/j.jpedsurg.2008.06.016 |
[10] |
Manabe Y, Uojima H, Hidaka H, Shao X, Iwasaki S, Wada N, et al. Undifferentiated embryonal sarcoma of the liver identified after the initial diagnosis of a hepatic cys. Intern Med 2020, 59:2375-2382.
doi: 10.2169/internalmedicine.4853-20 |
[11] | Li Y, Cai Q, Jia N, Chen D, Lu L, Cheng H. Pre-operatively misdiagnosed undifferentiated embryonal sarcoma of the liver: analysis of 16 case. Ann Transl Med 2015, 3:353. |
[12] | Yu XH, Huang J, Ge NJ, Yang YF, Zhao JY. Recurrent undifferentiated embryonal sarcoma of the liver in adult patient treated by pembrolizumab: A case report. World J Clin Cases 2021, 9:2281-2288. |
[13] |
Gabor F, Franchi-Abella S, Merli L, Adamsbaum C, Pariente D. Imaging features of undifferentiated embryonal sarcoma of the liver: a series of 15 childre. Pediatr Radiol 2016, 46:1694-1704.
doi: 10.1007/s00247-016-3670-3 |
[14] |
Xie ZY, Li LP, Wu WJ, Sun DY, Zhou MH, Zhao YG. Undifferentiated embryonal sarcoma of the liver mistaken for hepatic abscess in an adul. Oncology letters 2014, 8:1184-1186.
doi: 10.3892/ol.2014.2235 |
[15] |
Kunze G, Staritz M, Köhler M. Contrast-enhanced ultrasound in different stages of pyogenic liver absces. Ultrasound Med Biol 2015, 41:952-959.
doi: 10.1016/j.ultrasmedbio.2014.12.001 |
[16] |
Chen T, Chang X, Lv K, Wang Y, Fu X, Tan L, et al. Contrast-enhanced ultrasound features of intrahepatic cholangiocarcinoma: A new perspectiv. Sci Rep 2019, 9:19363.
doi: 10.1038/s41598-019-55857-6 |
[17] | Zhao CK, Xu HX, Guo LH, Sun LP, Yu M. A primary hepatic angiosarcoma mimicking intrahepatic cholangiocarcinoma on conventional ultrasound and contrast-enhanced ultrasound: A case report and review of literatures. Clin Hemorheol Microcirc 2017, 66:7-14. |
[18] | Geyer T, Clevert DA, Schwarz S, Reidler P, Gassenmaier S, Knösel T, et al. Diagnostic value of CEUS prompting liver biopsy: histopathological correlation of hepatic lesions with ambiguous imaging characteristic. Diagnostics (Basel, Switzerland) 2020, 11:35. |
[1] | Pengyan Zhang, MS, Ling Ren, MD, Yuguang You, BS, Wenjun Xiao, MS. Imaging Features and Misdiagnosis Analysis of Hyaline Vascular Castleman Disease in the Parotid Region: A Case Report [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(3): 302-304. |
[2] | Rui Chen, MM, Fangqi Guo, MM, Jia Guo, MD, Jiaqi Zhao, MD. Application and Prospect of AI and ABVS-based in Breast Ultrasound Diagnosis [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 130-135. |
[3] | Won-Chul Bang, PhD, Vice President, Yeong Kyeong Seong, PhD, Jinyong Lee. The Impact of Deep Learning on Ultrasound in Diagnosis and Therapy: Enhancing Clinical Decision Support, Workflow Efficiency, Quantification, Image Registration, and Real-time Assistance [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 204-216. |
[4] | Siyi Xun, MA, Wei Ke, PhD, Mingfu Jiang, MA, Huachao Chen, BA, Haoming Chen, BA, Chantong Lam, PhD, Ligang Cui, MD, Tao Tan, PhD. Current Status, Prospect and Bottleneck of Ultrasound AI Development: A Systemic Review [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 61-72. |
[5] | Rendong Chen, PhD, Xiaoqian Wang, BS, Ping Liang, MD, Xiaoping Ouyang, PhD, Dexing Kong, PhD. Intelligent Ultrasonic Diagnosis and Clinical Application: Technical Development and Prospectives [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 73-81. |
[6] | Wenjia Guo, MM, Shengli Li, MM, Xing Yu, MD, Huaxuan Wen, BM, Ying Yuan, MM, Xia Yang, MM. Artificial Intelligence in Prenatal Ultrasound: Clinical Application and Prospect [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 82-90. |
[7] | Changyan Wang, BS, Haobo Chen, MS, Jieyi Liu, BS, Changchun Li, BS, Weiwei Jiao, BS, Qihui Guo, BS, Qi Zhang, PhD. Deep Learning on Ultrasound Imaging for Breast Cancer Diagnosis and Treatment: Current Applications and Future Perspectives [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(2): 91-113. |
[8] | Priscilla Machado, MD, Ji-Bin Liu, MD, Flemming Forsberg, PhD. Sentinel Lymph Node Identification Using Contrast Lymphosonography: A Systematic Review [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(1): 1-7. |
[9] | Yixin Zhang, MS, Yuli Zhao, MS, Yuwen Su, MS, Sen Wang, MS, Li Feng, MD. Prenatal Ultrasound Diagnosis of Giant Cystic Meconium Peritonitis in Fetus Following in Vitro Fertilization: A Case Report [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(1): 42-46. |
[10] | Ping Wang, MM, Yuqun Luo, MM, Yunkai Li, MM, Wensheng Yue, MD, Duo Huang, MD, Xuemei Lin, MM, Shaoli Xie, MM, Bin Xiong, MM. A Misdiagnosed Cervical Vagal Schwannoma: A Case Report and Review of Its Imaging Features and Differential Diagnosis [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(1): 53-56. |
[11] | Shi Qiao, MM, Shaote Wang, MD, Yao Deng, MD, Feixiang Xiang, MD, Xiaojuan Qin, MD. Characterization of Pseudomyxoma Peritonei Originating from Ovarian Borderline Mucinous Tumor Using Ultrasonography: A Case Report [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(1): 57-59. |
[12] | Felipe Velasquez-Botero, MD, Ananya Balasubramanya, Ying Tang, MD, Qiang Lu, MD, Ji-Bin Liu, MD, John R. Eisenbrey, PhD. Renal Contrast-enhanced Ultrasound: Clinical Applications and Emerging Research [J]. Advanced Ultrasound in Diagnosis and Therapy, 2022, 6(4): 129-146. |
[13] | Ping Xu, MM, Heping Deng, MD, Bo Lu, MD, Yaru Mi, MM. Peripheral Nerve Lipomatosis: Pathology, Clinical Features, Imaging Diagnosis and Treatment [J]. Advanced Ultrasound in Diagnosis and Therapy, 2022, 6(4): 174-179. |
[14] | Ying Zhu, MD, Xiaohong Jia, MD, Yijie Dong, MD, Juan Liu, MD, Yilai Chen, MD, Congcong Yuan, MD, Weiwei Zhan, MD, Jianqiao Zhou, MD. Using S-Detect to Improve Breast Ultrasound: The Different Combined Strategies Based on Radiologist Experience [J]. Advanced Ultrasound in Diagnosis and Therapy, 2022, 6(4): 180-187. |
[15] | Huolin Ye, MD, Qiannan Huang, MD, Qingjing Zeng, MD, Xuqi He, MD, Erjiao Xu, MD, Yinglin Long, MD, Kai Li, MD, Rongqin Zheng, MD. Contrast-enhanced Ultrasound for Evaluation of Active Needle Tract Bleeding during Thermal Ablation of Liver Cancer [J]. Advanced Ultrasound in Diagnosis and Therapy, 2022, 6(3): 104-111. |
Viewed | ||||||
Full text |
|
|||||
Abstract |
|
|||||
Share: WeChat
Copyright ©2018 Advanced Ultrasound in Diagnosis and Therapy
|
Advanced Ultrasound in Diagnosis and Therapy (AUDT) a> is licensed under a Creative Commons Attribution 4.0 International License a>.