Limits...
Undifferentiated embryonal sarcoma of the liver mistaken for hepatic abscess in an adult.

Xie ZY, Li LP, Wu WJ, Sun DY, Zhou MH, Zhao YG - Oncol Lett (2014)

Bottom Line: The rapid recurrence of the tumor in this patient was identified by CT, and this is associated with the malignancy of the disease.Currently, patients with UESL have a poor prognosis as there is not a successful treatment strategy.The present study analyzes the course of diagnosis and potential treatment for the disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China.

ABSTRACT
Undifferentiated embryonal sarcoma of the liver (UESL) predominantly occurs in children under the age of 10 years, and ~90% of cases occur in children <15 years old. Patients may complain of abdominal pain, fever or other symptoms. No significant decrease has been identified in the hepatic function or elevation of α-fetoprotein, which differentiates UESL from primary carcinomas of the liver. In the present study, a rare and misdiagnosed case of an UESL arising in a male, which was mistaken for a hepatic abscess and retrospectively re-diagnosed, is reported. This case was misdiagnosed as a hepatic abscess initially, and it was diagnosed as UESL subsequent to performing tests, including a type-B ultrasonic scan and computed tomography (CT), and evaluating pathological findings. The rapid recurrence of the tumor in this patient was identified by CT, and this is associated with the malignancy of the disease. Currently, patients with UESL have a poor prognosis as there is not a successful treatment strategy. The present study analyzes the course of diagnosis and potential treatment for the disease.

No MeSH data available.


Related in: MedlinePlus

A low-density shadow in S8 of the liver, with a size of ~85×70 mm, a clear edge, an uneven density, a separate internal enhancement and no obvious solid component.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4114716&req=5

f2-ol-08-03-1184: A low-density shadow in S8 of the liver, with a size of ~85×70 mm, a clear edge, an uneven density, a separate internal enhancement and no obvious solid component.

Mentions: On admission, the body temperature of the patient was 38.5°C, the pulse rate was 80 beats/min and the blood pressure was 120/78 mmHg. The patient experienced a little pain when pressure was applied to the hepatic region. There was no evidence of an underlying liver disease upon serological examination, and tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen (CA-199), were negative, with the exception of α-feto protein (AFP) which was present at 13.14 μg/l (range, 0–7 μg/l). Serology was also negative for hepatitis A, B, C and E, syphilis and human immunodeficiency virus. The abdominal contrast-enhanced ultrasound revealed the presence of a cystic mass (90×67 mm) in the right hepatic region with homogeneous enhancement (Fig. 1). The abdominal computed tomography (CT) scan showed a UESL of 90 mm in maximum diameter, as well as cystic lesions with a low density that was reflected as a fluid (Fig. 2). Therefore, the initial diagnosis was a hepatic abscess and anti-infective therapy (0.6 g levofloxacin intraveneously once a day and 0.5g ornidazole intraveneously twice a day, both by intradermal injection) was administered. There was no improvement following 10 days of treatment and, therefore, the patient underwent ultrasound-guided liver puncture drainage. An 18-gauge puncture needle was used and the drainage tube was placed into the abscess cavity during the procedure, but it failed to drain the pus. The histopathological analysis of the liver tissue obtained by biopsy revealed atypical, multi-nucleated giant cells and abnormal cells (Fig. 3). By immunohistochemistry, the tumor cells were positive for vimentin and α-1-antichymotrypsin; negative for cytokeratin 7 (CK7), CK19, CK8/18, hepatocyte paraffin, mucin-1, cluster of differentiation 31 (CD31), CD34 and AFP; and the positive rate of Ki67 was 80%. Therefore, a diagnosis of UESL was determined and the patient underwent liver tumor resection and diaphragmatic tumor excision surgeries. During the surgery, the liver showed moderate-diffuse nodular sclerosis and the right lobe of the tumor diaphragmatic adhesions could not be separated. The tumor ulceration is normally removed and violation of the diaphragm is also taken into consideration (Fig. 4). The patient returned to our hospital to receive regular CT examinations and, after 2 months, it was found that the tumor had recurred, as shown by the CT imaging. The patient did not accept the option of postoperative chemotherapy due to economic problems and poor knowledge of the tumor.


Undifferentiated embryonal sarcoma of the liver mistaken for hepatic abscess in an adult.

Xie ZY, Li LP, Wu WJ, Sun DY, Zhou MH, Zhao YG - Oncol Lett (2014)

A low-density shadow in S8 of the liver, with a size of ~85×70 mm, a clear edge, an uneven density, a separate internal enhancement and no obvious solid component.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4114716&req=5

f2-ol-08-03-1184: A low-density shadow in S8 of the liver, with a size of ~85×70 mm, a clear edge, an uneven density, a separate internal enhancement and no obvious solid component.
Mentions: On admission, the body temperature of the patient was 38.5°C, the pulse rate was 80 beats/min and the blood pressure was 120/78 mmHg. The patient experienced a little pain when pressure was applied to the hepatic region. There was no evidence of an underlying liver disease upon serological examination, and tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen (CA-199), were negative, with the exception of α-feto protein (AFP) which was present at 13.14 μg/l (range, 0–7 μg/l). Serology was also negative for hepatitis A, B, C and E, syphilis and human immunodeficiency virus. The abdominal contrast-enhanced ultrasound revealed the presence of a cystic mass (90×67 mm) in the right hepatic region with homogeneous enhancement (Fig. 1). The abdominal computed tomography (CT) scan showed a UESL of 90 mm in maximum diameter, as well as cystic lesions with a low density that was reflected as a fluid (Fig. 2). Therefore, the initial diagnosis was a hepatic abscess and anti-infective therapy (0.6 g levofloxacin intraveneously once a day and 0.5g ornidazole intraveneously twice a day, both by intradermal injection) was administered. There was no improvement following 10 days of treatment and, therefore, the patient underwent ultrasound-guided liver puncture drainage. An 18-gauge puncture needle was used and the drainage tube was placed into the abscess cavity during the procedure, but it failed to drain the pus. The histopathological analysis of the liver tissue obtained by biopsy revealed atypical, multi-nucleated giant cells and abnormal cells (Fig. 3). By immunohistochemistry, the tumor cells were positive for vimentin and α-1-antichymotrypsin; negative for cytokeratin 7 (CK7), CK19, CK8/18, hepatocyte paraffin, mucin-1, cluster of differentiation 31 (CD31), CD34 and AFP; and the positive rate of Ki67 was 80%. Therefore, a diagnosis of UESL was determined and the patient underwent liver tumor resection and diaphragmatic tumor excision surgeries. During the surgery, the liver showed moderate-diffuse nodular sclerosis and the right lobe of the tumor diaphragmatic adhesions could not be separated. The tumor ulceration is normally removed and violation of the diaphragm is also taken into consideration (Fig. 4). The patient returned to our hospital to receive regular CT examinations and, after 2 months, it was found that the tumor had recurred, as shown by the CT imaging. The patient did not accept the option of postoperative chemotherapy due to economic problems and poor knowledge of the tumor.

Bottom Line: The rapid recurrence of the tumor in this patient was identified by CT, and this is associated with the malignancy of the disease.Currently, patients with UESL have a poor prognosis as there is not a successful treatment strategy.The present study analyzes the course of diagnosis and potential treatment for the disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China.

ABSTRACT
Undifferentiated embryonal sarcoma of the liver (UESL) predominantly occurs in children under the age of 10 years, and ~90% of cases occur in children <15 years old. Patients may complain of abdominal pain, fever or other symptoms. No significant decrease has been identified in the hepatic function or elevation of α-fetoprotein, which differentiates UESL from primary carcinomas of the liver. In the present study, a rare and misdiagnosed case of an UESL arising in a male, which was mistaken for a hepatic abscess and retrospectively re-diagnosed, is reported. This case was misdiagnosed as a hepatic abscess initially, and it was diagnosed as UESL subsequent to performing tests, including a type-B ultrasonic scan and computed tomography (CT), and evaluating pathological findings. The rapid recurrence of the tumor in this patient was identified by CT, and this is associated with the malignancy of the disease. Currently, patients with UESL have a poor prognosis as there is not a successful treatment strategy. The present study analyzes the course of diagnosis and potential treatment for the disease.

No MeSH data available.


Related in: MedlinePlus