Uncommon hepatic tumors: iconographic essay - Part 1

Most malignant liver tumors are represented by hepatocellular carcinoma and cholangiocarcinoma; however a variety of other uncommon hepatic lesions might also be found. Common lesions such as hemangioma, focal nodular hyperplasia and metastases are well known and have already been extensively documented in the literature. The diagnosis of typical hepatic lesions may be done with some reliability by means of several imaging methods; on the other hand, uncommon lesions normally represent a diagnostic challenge for the radiologist. In this first part of the study, the authors will approach five uncommon liver tumors - angiosarcoma, angiomyolipoma, cystadenoma/biliary carcinoma, epithelioid hemangioendothelioma, and fibrolamellar hepatocellular carcinoma -, describing their main characteristics and image findings with focus on computed tomography and magnetic resonance imaging.

Neoplasms; Liver; Atypical; Computed tomography; Magnetic resonance imaging

Authorship

Bruno Cheregati Pedrassa

MDs, Radiologists, Trainees at the Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilMDs, Radiologists, Trainees at the Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Eduardo Lima da Rocha

Marcelo Longo Kierszenbaum

Renata Lilian Bormann

Lucas Rios Torres

Master, Fellow PhD degree, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), MD, Radiologist, Hospital São Luiz, São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilMaster, Fellow PhD degree, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), MD, Radiologist, Hospital São Luiz, São Paulo, SP, Brazil.

Giuseppe D'Ippolito Mailing Address: Dr. Giuseppe D'Ippolito. Departamento de Diagnóstico por Imagem - EPM-Unifesp. Rua Napoleão de Barros, 800, Vila Clementino. São Paulo, SP, Brazil, 04024-012. E-mail: giuseppe_dr@uol.br

Private Docent, Professor, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilPrivate Docent, Professor, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Mailing Address: Dr. Giuseppe D'Ippolito. Departamento de Diagnóstico por Imagem - EPM-Unifesp. Rua Napoleão de Barros, 800, Vila Clementino. São Paulo, SP, Brazil, 04024-012. E-mail: giuseppe_dr@uol.br

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (9)

Thumbnail

Figure 1
Angiosarcoma. Ultrasonography demonstrates the presence of a predominantly hyperechogenic, heterogeneous hepatic mass occupying the whole right liver lobe.

Thumbnail

Figure 2
Angiosarcoma. Abdominal CT. At the non-contrast-enhanced phase, the presence of hypodense and heterogeneous liver masses is identified, intermingled with foci of calcifications. The largest of such masses occupies the whole right liver lobe (A). At the arterial phase, the mass presents intense enhancement by the iodinated contrast agent, representing hypervascularization (B), which remains at the portal (C) and delayed (D) phases.

Thumbnail

Figure 3
Angiomyolipoma. Ultrasonography demonstrates the presence of hyperechogenic liver mass with lobulated contours and central flow at Doppler, located in the segments VII/VIII.

Thumbnail

Figure 4
Angiomyolipoma. At abdominal MRI, the lesion presents subtle hypersignal on T1- weighted (A) and non homogeneous hypersignal on T2-weighted (B) sequences. At the out-ofphase sequence, marked signal dropout is observed, indicating fat component (C). After paramagnetic contrast injection, atypical enhancement is observed (D).

Thumbnail

Figure 5
A 42-year-old female patient with no previous history of disease, complaining of a painful, palpable mass in the epigastrium. Contrast-enhanced CT portal phase demonstrates cystic multiloculated lesion, with thick internal septa enhanced after contrast injection. The diagnosis was biliary cystadenocarcinoma.

Thumbnail

Figure 6
Biliary cystadenoma. Contrast-enhanced CT portal phase demonstrates cystic lesion with fine internal septa intermingled with foci of calcification.

Thumbnail

Figure 7
Epithelioid hemangioendothelioma. Non-contrast-enhanced abdominal CT identifies the presence of hypodense peripheral hepatic nodules intermingled with foci of calcifications (arrow on A), which may occur in up to 25% of cases. Chest CT of the same patient (B) demonstrates the presence of sparse secondary nodules randomly distributed on the pulmonary parenchyma. At abdominal CT portal phase (C,D) hepatic nodules present with more intense enhancement in the periphery of the lesion, hepatic capsule retraction (arrow on C), besides calcified lung metastases (arrow on D).

Thumbnail

Figure 8
Epithelioid hemangioendothelioma. A: Abdominal CT portal phase demonstrates the presence of hypovascular peripheral hepatic nodules. MRI demonstrates that the hepatic nodule presents low signal intensity at T1-weighted sequences (B) and high signal intensity at T2-weighted with target sign (C). At pelvic CT, insufflating osteolytic lesions are observed, with marginal sclerosis in the left iliac bone and scrum at right (D).

Thumbnail

Figure 9
A 23-year-old woman with no hepatopathy and negative tumor markers and with fibrolamellar hepatocellular carcinoma. Non-contrast-enhanced CT (A) arterial (B) and equilibrium (C) phases demonstrate the presence of a subtly hypodense large mass in the right liver lobe, with central punctiform calcifications presenting heterogeneous hypervascular enhancement with progressive appearance in its central region, intermingled with necrotic areas.

Figure 1 Angiosarcoma. Ultrasonography demonstrates the presence of a predominantly hyperechogenic, heterogeneous hepatic mass occupying the whole right liver lobe.

Figure 2 Angiosarcoma. Abdominal CT. At the non-contrast-enhanced phase, the presence of hypodense and heterogeneous liver masses is identified, intermingled with foci of calcifications. The largest of such masses occupies the whole right liver lobe (A). At the arterial phase, the mass presents intense enhancement by the iodinated contrast agent, representing hypervascularization (B), which remains at the portal (C) and delayed (D) phases.

Figure 3 Angiomyolipoma. Ultrasonography demonstrates the presence of hyperechogenic liver mass with lobulated contours and central flow at Doppler, located in the segments VII/VIII.

Figure 4 Angiomyolipoma. At abdominal MRI, the lesion presents subtle hypersignal on T1- weighted (A) and non homogeneous hypersignal on T2-weighted (B) sequences. At the out-ofphase sequence, marked signal dropout is observed, indicating fat component (C). After paramagnetic contrast injection, atypical enhancement is observed (D).

Figure 5 A 42-year-old female patient with no previous history of disease, complaining of a painful, palpable mass in the epigastrium. Contrast-enhanced CT portal phase demonstrates cystic multiloculated lesion, with thick internal septa enhanced after contrast injection. The diagnosis was biliary cystadenocarcinoma.

Figure 6 Biliary cystadenoma. Contrast-enhanced CT portal phase demonstrates cystic lesion with fine internal septa intermingled with foci of calcification.

Figure 7 Epithelioid hemangioendothelioma. Non-contrast-enhanced abdominal CT identifies the presence of hypodense peripheral hepatic nodules intermingled with foci of calcifications (arrow on A), which may occur in up to 25% of cases. Chest CT of the same patient (B) demonstrates the presence of sparse secondary nodules randomly distributed on the pulmonary parenchyma. At abdominal CT portal phase (C,D) hepatic nodules present with more intense enhancement in the periphery of the lesion, hepatic capsule retraction (arrow on C), besides calcified lung metastases (arrow on D).

Figure 8 Epithelioid hemangioendothelioma. A: Abdominal CT portal phase demonstrates the presence of hypovascular peripheral hepatic nodules. MRI demonstrates that the hepatic nodule presents low signal intensity at T1-weighted sequences (B) and high signal intensity at T2-weighted with target sign (C). At pelvic CT, insufflating osteolytic lesions are observed, with marginal sclerosis in the left iliac bone and scrum at right (D).

Figure 9 A 23-year-old woman with no hepatopathy and negative tumor markers and with fibrolamellar hepatocellular carcinoma. Non-contrast-enhanced CT (A) arterial (B) and equilibrium (C) phases demonstrate the presence of a subtly hypodense large mass in the right liver lobe, with central punctiform calcifications presenting heterogeneous hypervascular enhancement with progressive appearance in its central region, intermingled with necrotic areas.

How to cite

copy

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Português
Inglês

Versões e tradução automática

Versão original do texto

English
Português

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org