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Background and purpose:Hepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare, vascularly original tumor, and would be misdiagnosed easily in the clinical and imaging characteristics. This study aimed to investigate the imaging features of HEHE and our experience in clinical diagnosis and treatment, and to provide important reference for the diagnosis and treatment of HEHE in the future.Methods:This study retrospectively analyzed clinical manifestations, imaging features, pathological characteristics and treatment effects of 5 HEHE cases confirmed by pathology at Department of Integrative Cancer, Fudan University Shanghai Cancer Center.Results:The ratio of male to female patients was 2 to 3. HEHE predominantly occurred in middle-aged female patients whose ages range from 26 to 65 (mean=45.6). Imaging features of HEHE included multifocal hepatic disease (n=2), systemic multi-center multi-tissue occurrence (n=3). The ultrasound images showed isoechoic or hypoechoic lesions with no obvious blood lfow signal in the lesions. CT plain scan showed isointensity or hypointensity, while MR unenhanced with hypointense T1 signal and hyperintense T2 signal. The density or signal was uneven. Contrast-enhanced CT and MR images showed “slow in slow out”, obvious and variable degrees of peripheral rim enhancement. High FDG uptake showed delayed imaging characteristics (PET/CT). DSA angiography showed the tumor blood vessels were slim. After transcatheter arterial chemoembolization (TACE) surgery, lipiodol deposition within the lesion was not ideal. Under the microscope, tumor cells showed epithelial differentiation; angiogenesis was also visible. Immunohistochemistry staining showed CD31 and CD34 positive in all the 5 cases. Two cases treated with TACE combined with high intensity focused ultrasound (HIFU) and/or radiofrequency ablation (RFA) had good result.Conclusion:The clinical and radio-logical characteristics of HEHE are distinctive. Currently, for patients with systemic multi-organizational multi-center lesions, TACE combined with HIFU and/or RFA might be the most effective treatment method.
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Objective To compare the clinical usefulness of CT and DSA in evaluating the residual lesion and recurrence of tumor for primary hepatocellular carcinoma (PHC) after transcatheter arterial chemoembolization (TACE) with Lipiodol and to compare the effectiveness between CT and DSA. Methods Forty-five patients with HPC underwent CT and DSA within 1 - 6 months after 1 - 4 procedure(s) of TACE.The interval between two examinations was 3 - 5 days. The detection and demonstration of the residual lesions and the recurrence of tumor on CT and DSA were compared and the results were analyzed. Results The Lipiodol deposition appearance was classified into three patterns: complete compact pattern (n = 9,20% ), defect pattern (n = 32, 71.1% ) and discrete pattern (n = 4, 8.9% ). In patients with complete eompact pattern, no signs of recurrence were found on CT and DSA six months after the procedure. Of 32 patients with defect pattern, signs of recurrence on DSA and on dual-phase CT scans were found in 27 and in 19 respectively. During arterial phase, marked enhancement of the lesion was demonstrated in 16 cases,further enhancement in portal venous phase was manifested in 3 cases, which indicated that the portal vein participated in the tumor feeding. On DSA, the above enhancement areas showed pronounced opacification and vascularization. In another 8 cases, the CT signs and DSA findings were not in accord with each other, the lesions showed no enhancement on dual-phase CT scans but the lesions made their appearance as tumor's vessels and opacification. In patients of discrete pattern, only mild enhancement was seen on dual-phase CT scans, indicating that the tumor was of hypo-vascularization. Conclusion Both plain and dual-phase CT scanning can well demonstrate the residual lesions and the recurrence of hepatocellular carcinoma after TACE. Therefore, in evaluating the therapeutic results of TACE, CT study should be.considered as the examination of choice. DSA is the most sensitive and specific method for observing and assessing the therapeutic response. A combination of CT and DSA can more effectively guide the clinical treatment.
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Objective To compare the clinical usefulness of CT and DSA in evaluating the residual lesion and recurrence of tumor for primary hepatocellular carcinoma(PHC)after transcatheter arterial chemoembolization(TACE)with Lipiodol and to compare the effectiveness between CT and DSA.Methods Forty-five patients with HPC underwent CT and DSA within 1-6 months after 1-4 procedure(s)of TACE. The interval between two examinations was 3-5 days.The detection and demonstration of the residual lesions and the recurrence of tumor on CT and DSA were compared and the results were analyzed.Results The Lipiodol deposition appearance was classified into three patterns:complete compact pattern(n=9, 20%),defect pattern(n=32,71.1%)and discrete pattern(n=4,8.9%).In patients with complete compact pattern,no signs of recurrence were found on CT and DSA six months after the procedure.Of 32 patients with defect pattern,signs of recurrence on DSA and on dual-phase CT scans were found in 27 and in 19 respectively.During arterial phase,marked enhancement of the lesion was demonstrated in 16 cases, further enhancement in portal venous phase was manifested in 3 cases,which indicated that the portal vein participated in the tumor feeding.On DSA,the above enhancement areas showed pronounced opacification and vascularization.In another 8 cases,the CT signs and DSA findings were not in accord with each other,the lesions showed no enhancement on dual-phase CT scans but the lesions made their appearance as tumor's vessels and opacification.In patients of discrete pattern,only mild enhancement was seen on dual-phase CT scans,indicating that the tumor was of hypo-vascularization.Conclusion Both plain and dual-phase CT scanning can well demonstrate the residual lesions and the recurrence of hepatocellular carcinoma after TACE.Therefore,in evaluating the therapeutic results of TACE,CT study should be considered as the examination of choice.DSA is the most sensitive and specific method for observing and assessing the therapeutic response.A combination of CT and DSA can more effectively guide the clinical treatment.