Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma

doi:10.3748/wjg.v22.i19.4741

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

World J Gastroenterol. May 21, 2016; 22(19): 4741-4749
Published online May 21, 2016. doi: 10.3748/wjg.v22.i19.4741

Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma

Yi Dong, Wen-Ping Wang, Vito Cantisani, Mirko D’Onofrio, Andre Ignee, Lorenzo Mulazzani, Adrian Saftoiu, Zeno Sparchez, Ioan Sporea, Christoph F Dietrich

Yi Dong, Wen-Ping Wang, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Vito Cantisani, Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, 00185 Rome, Italy

Mirko D’Onofrio, Department of Radiology, GB Rossi University Hospital, University of Verona, 37121 Verona, Italy

Christoph F Dietrich, Andre Ignee, Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, 97980 Bad Mergentheim, Germany

Lorenzo Mulazzani, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy

Adrian Saftoiu, Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, 200349 Craiova, Romania

Adrian Saftoiu, Department of Endoscopy, Gastrointestinal Unit, Copenhagen University Hospital, DK-2730 Herlev, Denmark

Zeno Sparchez, Department of Gastroenterology, Institute for Gastroenterology and Hepatology, University of Medicine and Pharmacy, “Iuliu Hatieganu” Cluj-Napoca and Institute for Gastroenterology and Hepatology “O.Fodor”, 200349 Craiova, Romania

Ioan Sporea, Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Victor Babes, 300041 Timisoara, Romania

Author contributions: Dietrich CF is accepting full responsibility for the conduct of the study, he and all others had access to the data, all had control of the decision to publish; Christoph F planned the study; Dietrich CF, Dong Y, D’Onofrio M, and Cantisani V drafted the manuscript; Dietrich CF and Dong Y performed the statistical analysis; each author made a statement that they approved the final draft submitted; all authors conducted the study, collected and/or interpreted data, and critically revised the manuscript for important intellectual content.

Institutional review board statement: This study was a Retrospective Study, Institutional review board statement was applicable to our current study.

Informed consent statement: This study was a Retrospective Study, patients Informed consent statement was applicable to our current study.

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Data sharing statement: Each author gives permission to the graphic designers to alter the visual aspect of figures, tables, or graphs.

Correspondence to: Christoph F Dietrich, MD, PhD, MBA, Professor, Chief, Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim Uhlandstr 7, D-97980 Bad Mergentheim, Germany. christoph.dietrich@ckbm.de

Telephone: +49-7931-582201 Fax: +49-7931-582290

Received: January 8, 2016
Peer-review started: January 10, 2016
First decision: February 18, 2016
Revised: March 15, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: May 21, 2016
Processing time: 129 Days and 13 Hours

Abstract

AIM: To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma (HEHE) in comparison to other multilocular benign focal liver lesions (FLL).

METHODS: Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in consensus.

RESULTS: HEHE manifested as a single (n = 3) or multinodular (n = 22) FLL. On CEUS, HEHE showed rim-like (18/25, 72%) or heterogeneous hyperenhancement (7/25, 28%) in the arterial phase and hypoenhancement (25/25, 100%) in the portal venous and late phases (PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas (18/25, 72%); in seven patients (7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature (P < 0.01).

CONCLUSION: CEUS allows for characterization of unequivocal FLL. By analyzing the hypoenhancement in the PVLP, CEUS can determine the malignant nature of HEHE.

Keywords: Guidelines; Recommendations; Liver tumor; Biopsy; Liver transplantation Contrast enhanced ultrasound

Core tip: In this retrospective study, a large cohort of very rare histologically proven hemangioendothelioma (HEHE) was evaluated. Contrast-enhanced ultrasound (CEUS) allowed for improved detection of multilocular HEHE. HEHE showed typical enhancement patterns on CEUS. Therefore, CEUS can help to determine the malignant nature of HEHE.