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Hepatic epithelioid hemangioendothelioma: a report from three university centers
Antonello Giardino1, Frank H Miller2, Bobby Kalb3
1MD, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Universitá degli Studi di Milano, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Insights
Magnetic resonance imaging (MRI) reveals common findings for hepatic epithelioid hemangioendothelioma, including multiple peripheral lesions with characteristic ring enhancement. These imaging features aid in diagnosing this rare liver tumor.
Area of Science:
- Radiology
- Oncology
- Hepatology
Background:
- Hepatic epithelioid hemangioendothelioma (HEH) is a rare vascular liver tumor.
- Accurate imaging diagnosis is crucial for patient management.
Purpose of the Study:
- To identify and describe the typical magnetic resonance imaging (MRI) features of HEH.
- To correlate imaging findings with pathological diagnosis.
Main Methods:
- Retrospective review of MRI scans from seven patients with confirmed HEH.
- Analysis of lesion characteristics including number, location, enhancement patterns, and associated findings.
- Patients had no prior treatment at the time of imaging.
Main Results:
- All patients presented with focal hepatic masses.
- Lesions were predominantly peripheral (6/7), multifocal (>5 lesions), and showed capsular retraction (4/7).
- Characteristic enhancement pattern included early peripheral ring enhancement and delayed centripetal enhancement with a central core.
Conclusions:
- Multifocal, peripheral lesions with specific ring and delayed enhancement patterns are key MRI features of HEH.
- These findings can aid in differentiating HEH from other liver lesions.
- MRI is a valuable tool for the non-invasive diagnosis of hepatic epithelioid hemangioendothelioma.
Objective:
To determine common imaging findings of hepatic epithelioid hemangioendothelioma on magnetic resonance images.
Materials And Methods:
A search was made of three institutional databases between January 2000 and August 2012. Seven patients (mean age, 47 years; range, 21-66 years; 6 women) with pathology-confirmed diagnosis of hepatic epithelioid hemangioendothelioma who had undergone magnetic resonance imaging were identified. None of the patients had received any treatment for hepatic epithelioid hemangioendothelioma at the time of the initial magnetic resonance imaging examination.
Results:
Hepatic epithelioid hemangioendothelioma tumors appeared as focal masses in 7/7 patients, greater than 5 in number, with a coalescing lesion in 1/5, and peripheral localization in 6/7. Capsular retraction was present in 4/7, and was associated with peripherally located lesions. Early ring enhancement was appreciated in the majority of lesions in 7/7 patients. Centripetal progressive enhancement was shown in 5/7 patients on venous phase that exhibited a distinctive thick inner border of low signal on venous phase images, and a central core of delayed enhancement. Small lesions did not show this.
Conclusion:
The combination of multifocal round-configuration lesions that are predominantly peripheral and exhibit early peripheral ring enhancement and late appearance of an inner thick border of low signal and central core of high signal may represent an important feature for hepatic epithelioid hemangioendothelioma.
