CT features of primary hepatic fibrosarcoma / 中华消化外科杂志

ABSTRACT

Objective:To investigate the computed tomography (CT) features of primary hepatic fibrosarcoma (PHF).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 8 patients with PHF who were admitted to 2 medical centers from January 2010 to December 2019, including 3 cases of Yueqing People's Hospital of Zhejiang and 5 cases of Wenzhou People's Hospital of Zhejiang were collected. There were 5 males and 3 females, aged 50 years(range, 39?60 years). All patients underwent abdominal CT plain and enhanced examination, and surgical procedures were selected based on patients' will and individual situations. Surgical tumor specimens were given pathological examination and immunohistochemical staining. Observation indicators (1) imaging features of CT examination; (2) treatment and pathological examinations; (3) follow-up. Follow-up was performed by outpatient examination or hospitalization to detect survival of patients and tumor recurrence up to December 2020. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of CT examination 8 patients received preoperative CT examinations, 3 cases of which were diagnosed as malignancies, 3 cases were diagnosed as hepatic space-occupying lesions, 2 cases were diagnosed as intrahepatic cholangiocarcinoma. ① Tumor location and general status 8 patients had single tumor, of which 6 cases had tumor located in the right lobe of the liver and 2 cases had tumor located in the left lobe of the liver. The tumor was in oval shape in 5 patients and in circular in 3 patients. The maximum diameter of tumor in 8 patients was 9.3 cm(range, 4.0?15.0 cm). There were 1 case with tumor maximum diameter ≤5.0 cm, 4 cases with tumor maximum diameter as 5.1?10.0 cm, 3 cases with tumor maximum diameter >10.0 cm. ② CT plain scan showed uniform low density in 2 cases and uneven low density in 6 cases and the CT value of 8 cases was 40 HU(range, 29?43 HU). The tumor showed expansive growth with clear boundary in 6 cases, and invasive growth with unclear boundary in 2 cases. Five cases had intratumoral necrosis and cystic transformation, 2 cases had intratumoral strip hemorrhage, and 1 case of intratumoral calcification. There was 1 case with hilar lymph node metastasis. ③ Enhanced CT scan showed 8 cases with uneven enhancement in arterial phase, 8 cases with uneven tumor density in portal vein phase, 8 cases with intratumoral enhancement slowly withdrew in delayed phase and the density lower than liver parenchyma. (2) Treatment and pathological examinations ① 8 patients under-went surgical resection, without intrahepatic or hilar metastasis. ② The results of postoperative pathological examination showed 2 cases with grade Ⅰ tumor differentiation (low potential malignancy), 5 cases with grade Ⅱ and Ⅲ tumor differentiation (moderate potential malignancy), 1 case with grade Ⅳ tumor differentiation (high potential malignancy). ③ Immuno-histochemical staining showed that 8 cases were positive for vimentin, CD10, p53 and negative for smooth muscle actin, keratin19, epithelial membrane antigen, endotheliocyte 34. All 8 patients were diagnosed as PHF. (3) Follow-up all 8 patients were followed up for 7 to 128 months, with a median follow-up time of 53 months. The overall survival time of 8 patients was 15 to 122 months, and the median overall survival time was 45 months. One patient died of tumor recurrence and distant metastasis at 17 months after surgery, and the survival time of 7 patients was >28 months.Conclusions:CT plain scan of PHF showed uneven low-density masses. After enhancement, the arterial phase shows the tumor ring or peripheral nodular uneven enhancement, the intratumoral strip-shaped enhanced blood vessels. The portal vein phase shows the tumor-like small patches or grid-like continuous enhancement. The delayed phase is characterized by the slow withdrawal of intratumoral enhancement.