EURORAD ESR

Case 10538

Hepatic epithelioid haemangioendothelioma: diagnostic imaging

Author(s)
Sergio Savastano1, Alessandra Costantini1, Antonio Perasole2, Stefano Trupiani1, Andrea Busolo1, Emanuele D’Amore2

U.O. Radiologia1 and
U.O. Anatomia e Istocitopatologia2
Ospedale San Bortolo
V.le F. Rodolfi 37
36100 Vicenza, Italy;
email: sergio.savastano@ulssvicenza.it
 
Patient
female, 36 year(s)
 
 
  • Figure 1
    Colour Doppler of the liver

    Peripheral hypoechoic nodule with no vascular signals.

     
    Area of Interest: Liver; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 2
    Contrast-enhanced CT.

    Hypoattenuating hepatic nodules. Amputation of a portal branch entering the more central nodule is appreciable.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 3
    Whole body F18-FDG PET

    No abnormal hyperactivity; however, the liver shows an inhomogeneous activity.

     
    Area of Interest: Liver; Imaging Technique: PET; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;
     
     
  • Figure 4
    MRI of the liver.
     

    T1 out-of-phase GE imaging (TR/TE 100/1.23): hypointense hepatic nodules.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;

    HASTE T2W-FS-MRI (TR/TE 1600/95): high signal intensity of hepatic masses; the lesion located in the central portion of S8 shows a more pronounced hyperintense core.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;

    Coronal HASTE T2W-MRI (TR/TE 1400/89): target-like apprearance of two hepatic nodules. Pyelectasis of the right kidney is visible.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;

    T1 out-of-phase GE imaging (TR/TE 100/1.23): a peripheral nodule with capsular retraction.

     
    Area of Interest: Liver; Imaging Technique: MR-Angiography; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;
     
     
  • Figure 5
    DWI.
     

    DWI b50: two hyperintense subcapsular nodule in the right lobe of the liver.

     
    Area of Interest: Liver; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;

    DWI b800: restriction to water diffusion is more pronounced in the more ventral nodule.

     
    Area of Interest: Liver; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;

    ADC map: the nodules have different ADC values (700 mm2/s and 1700 mm2/s).

     
    Area of Interest: Liver; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;
     
     
  • Figure 6
    Contrast-enhanced (Gd-BOPTA) 3D-MRI (TR/TE 3.78/1.76).
     

    Arterial phase: nodules appear hypointense relative to the liver; some of the lesions exhibit some peripheral enhancement (target sign).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;

    Delayed venous phase: centripetal filling of nodules.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;

    10 minutes after the contrast medium administration: nodules are homogenously hyperintense relative to intervening parenchyma.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;

    Hepatobiliary phase: lesions do not take up the liver-specific contrast medium.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;
     
     
  • Figure 7
    Histology from US guided bioptic specimen

    Sparse single atypical epithelioid uni- or multivacuolated cells (upper half, yellow circles - H/E stain x200) and thin capillaries embedded in a dense fibrous matrix positive for CD34 markers at immunostaining (lower...

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;
     
     
Peripheral hypoechoic nodule with no vascular signals.
 
Hypoattenuating hepatic nodules. Amputation of a portal branch entering the more central nodule is appreciable.
 
No abnormal hyperactivity; however, the liver shows an inhomogeneous activity.
 
T1 out-of-phase GE imaging (TR/TE 100/1.23): hypointense hepatic nodules.
 
HASTE T2W-FS-MRI (TR/TE 1600/95): high signal intensity of hepatic masses; the lesion located in the central portion of S8 shows a more pronounced hyperintense core.
 
Coronal HASTE T2W-MRI (TR/TE 1400/89): target-like apprearance of two hepatic nodules. Pyelectasis of the right kidney is visible.
 
T1 out-of-phase GE imaging (TR/TE 100/1.23): a peripheral nodule with capsular retraction.
 
DWI b50: two hyperintense subcapsular nodule in the right lobe of the liver.
 
DWI b800: restriction to water diffusion is more pronounced in the more ventral nodule.
 
ADC map: the nodules have different ADC values (700 mm2/s and 1700 mm2/s).
 
Arterial phase: nodules appear hypointense relative to the liver; some of the lesions exhibit some peripheral enhancement (target sign).
 
Delayed venous phase: centripetal filling of nodules.
 
10 minutes after the contrast medium administration: nodules are homogenously hyperintense relative to intervening parenchyma.
 
Hepatobiliary phase: lesions do not take up the liver-specific contrast medium.
 
Sparse single atypical epithelioid uni- or multivacuolated cells (upper half, yellow circles - H/E stain x200) and thin capillaries embedded in a dense fibrous matrix positive for CD34 markers at immunostaining (lower half ).
 
 
 
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