Hepatic epithelioid hemangioendothelioma: Challenges in the preoperative diagnosis

Zhang, Lan; Chen, Xin Ju; Lee, Jeong Min; Lin, Song

doi:10.1016/j.kjms.2018.04.009

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…The "multilayer ring appearance" is considered a characteristic of HEHE. Previous studies have termed this ring structure as a "target-like sign" (19,21), such as "white targetlike", and "black target-like" (26). The "white target-like sign" is defined by a nodular enhancement in the central part of the lesion in the arterial phase surrounded by ring-like enhancement in the portal venous and delayed phases (26).…”

Section: Discussionmentioning

confidence: 99%

“…Imaging examination is one of the main methods for diagnosing liver lesions (16,17). However, the diagnosis of HEHE can be difficult (18,19), and pathological examination is often needed. Early detection of HEHE based on imaging findings is one of the main clinical challenges in the study of this disease (19).…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies have explored the imaging features of HEHE and demonstrated several characteristics, such as early peripheral ring enhancement, capsule retraction, and the "lollipop" sign (19)(20)(21)(22)(23). However, further studies are required to improve diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

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Novel and Specific MRI Features Indicate the Clinical Features of Patients With Rare Hepatic Tumor Epithelioid Hemangioendothelioma

Zhang

Zhong

et al. 2022

Front. Oncol.

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ObjectiveTo investigate the MRI features and clinical significance of hepatic epithelioid hemangioendothelioma (HEHE).MethodsClinical records and MRI findings were retrospectively evaluated in nine HEHE patients from May 2010 to January 2020.ResultThere were 121 lesions in nine patients with a predominantly peripheral distribution. Five lesions (4.13%) in two patients (22.22%) had evidence of capsular retraction, and three patients had lung metastasis (33.33%). Dynamic contrast-enhanced MRI showed progressive enhancement, mainly in two ways: ring enhancement with hypovascularity in four patients (44.44%) and ring enhancement with hypervascularity in five patients (55.56%). Imaging demonstrated a multilayer ring appearance, which was typically observed on T2-weighted imaging (T2WI). The most common appearance consisted of two layers of varying signal, with some images displaying up to four layers. There were significant differences in the size of lesions between different layers of multilayer ring appearance (p < 0.001). All lesions exhibited a two-layer appearance on diffusion-weighted imaging (DWI), with hyperintensity at the periphery and a slightly high signal at the center (except for those with a single layer on T2WI). The “vascular penetration sign” was observed in most lesions, and the blood vessels of 112 lesions (92.56%) were portal vein branches, and five (4.13%) were hepatic vein branches. Pulmonary metastasis was found in three patients with the “vascular penetration sign” of hepatic vein branches.ConclusionThe multilayer ring appearance on T2WI, the “vascular penetration sign”, and the two enhancement patterns may be of great significance in the diagnosis and treatment of HEHE. The “vascular penetration sign” of hepatic vein branches may indicate extrahepatic metastasis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Novel and Specific MRI Features Indicate the Clinical Features of Patients With Rare Hepatic Tumor Epithelioid Hemangioendothelioma

Zhang

Zhong

et al. 2022

Front. Oncol.

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“…If the bulb of NMR is also found, the diagnostic accuracy can be improved. [ 12 ]. Presurgery preparation: this should include liver function Child–Pugh classification, routine blood tests, and coagulation function.…”

Section: Discussionmentioning

confidence: 99%

[Retracted] Comparison of Hepatectomy and Hemangiomas Stripping on Patients with Giant Hepatic Hemangiomas

Yang

et al. 2022

Contrast Media & Molecular Imaging

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Objective. To compare the value of a hepatectomy and hemangioma stripping on patients with giant hepatic hemangiomas. Methods. Seventy-four patients with giant hepatic hemangiomas were retrospectively analyzed from data collected from their hepatobiliary surgeries performed from June 2010 to June 2015 at the People’s Hospital of Ningxia and the general hospital affiliated with Ningxia Medical University. The patients were divided into a hepatectomy group (37 patients) and a hemangioma-stripping group (37 patients). Conditions of each group were compared before and after surgery and comprised of surgery duration, intraoperative blood loss, blood transfusion, duration of hepatic blood occlusion, and hospital stay. Any complications after surgery, such as pleural effusions, bile leakage, and abdominal hemorrhage, were also observed. Results. In the hemangioma-stripping group, the surgery time was 2.38 ± 0.93 h, intraoperative blood loss was 889.19 ± 756.37, blood transfusion amount was 723.78 ± 801.14, the duration of hepatic blood occlusion 26.84 ± 17.30 min, and hospital stay was 16.19 ± 5.01 d. In the hepatectomy group, surgery time was 3.26 ± 1.16 h, intraoperative blood loss was 1551.35 ± 1755.88 mL blood transfusion amount was 1693.24 ± 2117.72 mL, duration of hepatic blood occlusion was 26.84 ± 17.30 min, and hospital stay was 16.19 ± 5.01 d. The difference between the groups was statistically significant (P < 0.05). The pleural effusion incident rate in the former group was lower than that of the latter group, and the difference was statistically significant. Conclusions. Hemangiomas stripping is an effective method by which to cure hepatic hemangioma, with the advantages being a relatively easy surgery with less patient trauma, rapid recovery, and fewer complications. This method should be used more often in clinical settings.

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“…HEHE is generally considered as a low‐grade malignant tumor with a clinical course between hemangioma and angiosarcoma. HEHE has an uncertain malignant potential 2 with uneven clinical course, its survival time ranges from 2 weeks 3 to 27 years 4 after diagnosis, the mortality rate ranges from 40% to 65%. 1 …”

Section: Introductionmentioning

confidence: 99%

Three cases of hepatic epithelioid hemangioendothelioma evaluated using conventional and contrast‐enhanced ultrasound: Case reports

Jian-qiang

Zhao

et al. 2022

J of Clinical Ultrasound

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Hepatic epithelioid hemangioendothelioma (HEHE) is a very rare vascular endothelial cell tumor, which lacks typical clinical manifestations and specificity of imaging features. Whether the background of fatty liver and the difference in Contrast enhanced ultrasound (CEUS) characteristics between large and small lesions has not been well defined. In this case reports, we described the ultrasound image features of three patients with HEHE. These three patients with HEHE have certain similar characteristics of conventional ultrasound and CEUS. CEUS imaging features include large nodules show earlier perfusion than liver parenchyma, with rim‐enhancement, nonenhancing regions in the center, while small nodules show earlier perfusion than liver parenchyma, with hyperenhancement. All nodules show faster washout than hepatic parenchyma, showing heterogeneous hypoenhancement, and more washout lesions can be found in the PVP and LP. Conventional ultrasound and CEUS not only help to improve the diagnostic confidence of HEHE of rare liver tumors, but also can guide the biopsy area, making it easier to make accurate pathological diagnosis.

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Hepatic epithelioid hemangioendothelioma: Challenges in the preoperative diagnosis

Cited by 5 publications

References 5 publications

Novel and Specific MRI Features Indicate the Clinical Features of Patients With Rare Hepatic Tumor Epithelioid Hemangioendothelioma

Novel and Specific MRI Features Indicate the Clinical Features of Patients With Rare Hepatic Tumor Epithelioid Hemangioendothelioma

[Retracted] Comparison of Hepatectomy and Hemangiomas Stripping on Patients with Giant Hepatic Hemangiomas

Three cases of hepatic epithelioid hemangioendothelioma evaluated using conventional and contrast‐enhanced ultrasound: Case reports

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