Unusual Mesenchymal Liver Tumors in Adults: Radiologic-Pathologic Correlation
Kyoung Ah Kim1,
Kyoung Won Kim1,
Seong Ho Park1,
Se Jin Jang2,
Mi-Suk Park3,
Pyo Nyun Kim1,
Moon-Gyu Lee1 and
Hyun Kwon Ha1
1 Department of Radiology, University of Ulsan College of Medicine and Asan
Medical Center, 388-1, Pungnap-2 dong, Songpa-ku, Seoul 138-736, South
Korea.
2 Department of Diagnostic Pathology, University of Ulsan College of Medicine
and Asan Medical Center, Seoul, South Korea.
3 Department of Radiology, YounDong Severance Hospital, Seoul, South
Korea.
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Fig. 1A —40-year-old woman with mesenchymal hamartoma in right hepatic
lobe that was incidentally found at sonography. Transverse sonogram shows
large mass composed of admixture of cystic (arrowheads) and solid
(arrows) compartments in right lobe of liver.
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Fig. 1B —40-year-old woman with mesenchymal hamartoma in right hepatic
lobe that was incidentally found at sonography. Color Doppler sonogram shows
hypervascularity in solid portion (arrowheads) of mass.
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Fig. 1C —40-year-old woman with mesenchymal hamartoma in right hepatic
lobe that was incidentally found at sonography. Contrast-enhanced CT scan
shows strong enhancement in solid portion (arrow) and mild
enhancement in intervening septa (arrowheads) between cystic
parts.
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Fig. 1D —40-year-old woman with mesenchymal hamartoma in right hepatic
lobe that was incidentally found at sonography. On coronal true fast image
with steady-state free precession (FISP), solid component and intervening
septa are seen as intermediate high signal intensity, whereas cystic portion
is seen as bright high signal intensity.
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Fig. 1E —40-year-old woman with mesenchymal hamartoma in right hepatic
lobe that was incidentally found at sonography. Low-power photomicrograph
shows thick-walled vessels and bile ducts embedded in dense fibrous stroma,
suggestive of mesenchymal hamartoma. (H and E, original magnification
x20)
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Fig. 2A —43-year-old woman with angiomyolipoma in right hepatic lobe
that was incidentally found at sonography. Oblique sagittal sonogram shows
ovoid echogenic mass (arrows) in right lobe of liver.
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Fig. 2B —43-year-old woman with angiomyolipoma in right hepatic lobe
that was incidentally found at sonography. Unenhanced CT scan shows
hypoattenuation of lesion (arrows) compared with liver parenchyma,
but attenuation is not as low as that of subcutaneous fat.
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Fig. 2C —43-year-old woman with angiomyolipoma in right hepatic lobe
that was incidentally found at sonography. Contrast-enhanced CT scan during
hepatic artery phase shows hypervascular staining of tumor
(arrows).
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Fig. 2D —43-year-old woman with angiomyolipoma in right hepatic lobe
that was incidentally found at sonography. On contrast-enhanced CT scan during
portal venous phase, lesion is seen as hypoattenuation (arrows).
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Fig. 2E —43-year-old woman with angiomyolipoma in right hepatic lobe
that was incidentally found at sonography. High-power photomicrograph shows
admixture of adipose tissue, smooth muscle, and thick-walled blood vessels,
suggesting diagnosis of angiomyolipoma. (H and E, original magnification
x200)
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Fig. 2F —43-year-old woman with angiomyolipoma in right hepatic lobe
that was incidentally found at sonography. On immunohistochemical study,
specimen shows positivity for human melanocyte-specific antibody (HMB 45),
supporting diagnosis of angiomyolipoma.
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Fig. 3A —34-year-old woman with myofibroblastoma in right hepatic lobe
that was incidentally found on sonography. Transverse sonogram shows
predominantly cystic mass with multiple internal septa (arrowheads)
and eccentrically located solid portion (arrows) in liver.
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Fig. 3B —34-year-old woman with myofibroblastoma in right hepatic lobe
that was incidentally found on sonography. T2-weighted axial MR image well
shows admixture of solid and cystic mass (arrowheads).
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Fig. 3C —34-year-old woman with myofibroblastoma in right hepatic lobe
that was incidentally found on sonography. Delayed phase contrast-enhanced MR
image after administration of gadopentetate dimeglumine shows intense
enhancement in solid portion (arrowheads). This finding correlates
with abundant fibrous tissue seen on histopathologic examination.
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Fig. 3D —34-year-old woman with myofibroblastoma in right hepatic lobe
that was incidentally found on sonography. Photograph of specimen shows
predominantly cystic mass with trabeculated internal surface.
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Fig. 3E —34-year-old woman with myofibroblastoma in right hepatic lobe
that was incidentally found on sonography. Low-power photomicrograph shows
abundant fibrous tissue and inflammatory cells consisting of plasma cells,
lymphocytes, neutrophils, and occasional eosinophils. (H and E, original
magnification x40)
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Fig. 4A —32-year-old woman with epithelioid hemangioendotheliomas in
hepatic right lobe who presented with epigastric pain for 2 months. Oblique
sagittal sonogram shows multiple ill-defined hypoechoic lesions with target
appearance (arrowheads) in right lobe of liver.
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Fig. 4B —32-year-old woman with epithelioid hemangioendotheliomas in
hepatic right lobe who presented with epigastric pain for 2 months.
Contrast-enhanced CT scan shows multiple discrete low-attenuation lesions
(arrows) in periphery of right hepatic lobe. Capsular retraction
(arrowheads) adjacent to one nodule and extending to capsular surface
is clearly seen.
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Fig. 4C —32-year-old woman with epithelioid hemangioendotheliomas in
hepatic right lobe who presented with epigastric pain for 2 months.
T2-weighted axial MR image shows heterogeneous high signal intensity of
lesions with target appearance (arrows) and capsular retraction
(arrowheads).
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Fig. 4D —32-year-old woman with epithelioid hemangioendotheliomas in
hepatic right lobe who presented with epigastric pain for 2 months.
T2-weighted axial MR image shows another target appearance of lesion with
central areas of low signal intensity (arrowhead).
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Fig. 4E —32-year-old woman with epithelioid hemangioendotheliomas in
hepatic right lobe who presented with epigastric pain for 2 months. High-power
photomicrograph shows spindle or oval tumor cells scattered in fibromyxoid
stroma. Some tumor cells show intracytoplasmic vacuoles. (H and E, original
magnification x200)
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Fig. 4F —32-year-old woman with epithelioid hemangioendotheliomas in
hepatic right lobe who presented with epigastric pain for 2 months. On
immunohistochemical staining, tumor cells show positivity for CD34
antigen.
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Fig. 5A —24-year-old man with angiosarcomas in both hepatic lobes who
presented with epigastric pain for 2 months. Unenhanced CT scan shows multiple
masses that are predominantly hypoattenuating compared with surrounding
hepatic parenchyma mixed with hyperattenuation area (arrow) caused by
fresh internal hemorrhage. Note also areas of low attenuation near that of
fluid (arrowheads), representing site of old hemorrhage.
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Fig. 5B —24-year-old man with angiosarcomas in both hepatic lobes who
presented with epigastric pain for 2 months. On contrast-enhanced CT scan
during hepatic artery phase, most lesions are seen as hypoattenuating, and
foci of enhancement are present. Such enhancement is bizarre in shape, with
ring enhancement seen in some nodules (arrowheads).
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Fig. 5C —24-year-old man with angiosarcomas in both hepatic lobes who
presented with epigastric pain for 2 months. Low-power photomicrograph shows
that tumor nodule is composed of pleomorphic endothelial cells, fibrous septa
with atypical endothelial cells, and blood pooling. (H and E, original
magnification x40)
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Fig. 5D —24-year-old man with angiosarcomas in both hepatic lobes who
presented with epigastric pain for 2 months. On immunohistochemical staining,
tumor cells show positivity for coagulation factor VIII.
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Fig. 6A —44-year-old woman with undifferentiated embryonal sarcoma in
left hepatic lobe who presented with right upper quadrant discomfort for 1
year. Transverse sonogram shows large, well-defined, mixed echogenic mass with
multiple anechoic spaces (asterisk) in left hepatic lobe.
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Fig. 6B —44-year-old woman with undifferentiated embryonal sarcoma in
left hepatic lobe who presented with right upper quadrant discomfort for 1
year. Unenhanced CT scan shows low-attenuation mass with well-demarcated
margin nearly replacing left lateral segment of liver.
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Fig. 6C —44-year-old woman with undifferentiated embryonal sarcoma in
left hepatic lobe who presented with right upper quadrant discomfort for 1
year. On contrast-enhanced CT scan, mass is seen as misleading cystlike
appearance, but mild septalike peripheral enhancement (arrowheads) is
also seen.
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Fig. 6D —44-year-old woman with undifferentiated embryonal sarcoma in
left hepatic lobe who presented with right upper quadrant discomfort for 1
year. High-power photomicrograph shows malignant cells that are stellate or
spindle in shape and compactly arranged in a myxoid stroma with
pseudocapsule.
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Fig. 7A —44-year-old man with malignant fibrous histiocytoma in right
hepatic lobe who presented with right upper quadrant discomfort for 6 months.
Unenhanced CT scan shows large hypodense mass with profound low-attenuation
areas of necrosis (asterisk).
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Fig. 7B —44-year-old man with malignant fibrous histiocytoma in right
hepatic lobe who presented with right upper quadrant discomfort for 6 months.
Contrast-enhanced CT scan during portal venous phase shows inhomogeneous and
multiple irregular septalike streaky areas of enhancement in periphery.
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Fig. 7C —44-year-old man with malignant fibrous histiocytoma in right
hepatic lobe who presented with right upper quadrant discomfort for 6 months.
Photograph of cut surface of gross specimen shows mass composed of ill-defined
white, whirled, and fibrous tissue, with multifocal necrotic and focal
hemorrhagic lesions. Hepatic capsule is not involved.
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Copyright © 2006 by the American Roentgen Ray Society.
