Skip to main content

Advertisement

SpringerLink
Log in

MRI features of primary rare malignancies of the liver: A report from four university centres

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine if rare primary malignancies of the liver may have consistent features on magnetic resonance imaging (MRI).

Materials and methods

This IRB-compliant retrospective study reviewed the records from the pathology departments of four university centres over an 11-year period from 2005-2016 to identify rare primary malignant tumours, which were cross-referenced with MRI records. MRI studies of these patients were reviewed to determine if these tumours exhibited consistent and distinctive features.

Results

Sixty patients were identified with rare primary liver tumours. The following distinctive features and frequency of occurrence were observed: mixed hepatocellular carcinoma-cholangiocarcinoma showed regions of wash-out in 7/19 of patients; 6/6 of fibrolamellar carcinomas demonstrated large heterogeneous lesions with large heterogeneous central scars; epithelioid haemangioendothelioma larger than 2 cm showed target-like enhancement in late-phase enhancement in 9/13; sarcomas excluding angiosarcoma had central necrosis in 3/9 and haemorrhage in 5/9; angiosarcomas showed centripedal progressive nodular enhancement in 3/6 and showed regions of haemorrhage in 3/6; and 7/7 of primary hepatic lymphomas showed encasement of vessels.

Conclusion

Although helpful features for the differentiation of rare primary malignancies of the liver are identified, no MRI features appear to be specific and therefore histopathological confirmation is usually required for definitive diagnosis.

Key points

• No MRI features appear to be specific for rare primary liver malignancies.

• Haemorrhage is a helpful sign in diagnosis of primary hepatic sarcomas.

• Angiosarcomas may show progressive nodular enhancement towards the centre mimicking haemangioma.

• Vessel encasement is a helpful sign in diagnosis of primary hepatic lymphoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

AS:

Angiosarcoma

CCA:

Cholangiocarcinoma

EHE:

Epithelioid haemangioendothelioma

FL:

Fibrolamellar hepatocellular carcinoma

HCC:

Hepatocellular carcinoma

PHL:

Primary hepatic lymphoma

References

  1. Matos AP, Velloni F, Ramalho M, AlObaidy M, Rajapaksha A, Semelka RC (2015) Focal liver lesions: Practical magnetic resonance imaging Approach. World J Hepatol 7:1987–2008

    Article  PubMed  PubMed Central  Google Scholar 

  2. Braga L, Altun E, Armao D, Semelka RC (2015) Liver. In: Semelka RC, Brown M, Altun E (eds) Abdominal-pelvic MRI, 4th edn. Wiley-Blackwell Hooken, NJ, pp 39–393

    Chapter  Google Scholar 

  3. Park JH, Jang KM, Kang TW et al (2016) Identification of imaging predictors discriminating different primary liver tumors in patients with chronic liver disease on gadoxetic acid-enhanced MRI: A classification tree analysis. Eur Radiol 26:3102–3111

    Article  PubMed  Google Scholar 

  4. Economopoulous N, Kelekis NL, Argentos S et al (2008) Bright-dark sign in MR imaging of hepatic hemangioendtohelioma. J Magn Reson Imaging 27:908–912

    Article  Google Scholar 

  5. Crider MH, Hoggard E, Manivel JC (2009) Undifferentiated (Embryonal) Sarcoma of the Liver. Radiographics 29:1665–1668

    Article  PubMed  Google Scholar 

  6. LV WF, Han JK, Cheng DL, Tang WJ, Lu D (2015) Imaging features of primary hepatic leiomyosarcoma: A case report and review of literature. Oncol Lett 9:2256–2260

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chelimilla H, Badipatla K, Ihimoyan A, Niazi M (2013) A Rare Occurrence of Primary Hepatic Leiomyosarcoma Associated with Epstein Barr Virus Infection in an AIDS Patient. Case Rep in Gastrointestinal Med 2013:691862. https://doi.org/10.1155/2013/691862

    Google Scholar 

  8. Wunderbaldinger P, Turetschek K (1998) Primary Malignant Fibrous Histiocytoma of the Liver: CT and MR Findings. Am J Roentgenol 171:900–901

    Article  CAS  Google Scholar 

  9. Sunnapwar A, Katre R, Poicarpio-Nicolas M, Katabathina V, Erian M (2016) Imaging of rare primary malignant hepatic tumors in adults with histopathologic correlation. J Comp Assist Tomogr 40:452–462

    Article  Google Scholar 

  10. Tan Y, Xiao E-H (2013) Rare hepatic malignant tumors: dynamic CT, MRI, and clinicopathologic features: with analysis of 54 cases and review of the literature. Abdom Imaging 38:511–526

    Article  PubMed  Google Scholar 

  11. Goodman ZD, Ishak KG, Langloss JM et al (1985) Combined hepatocellular-cholangiocarcinoma. A histologic and immunohistochemical study. Cancer 55:124–135

    Article  CAS  PubMed  Google Scholar 

  12. Theise ND, Nakashima O, Park YN, Nakanuma Y (2010) Combined hepatocellular carcinoma-cholangiocarcinoma. WHO classification of tumours of the digestive system, 4th edn. IARC Press, Lyon

    Google Scholar 

  13. Fowler KJ, Sheybani A, Parker RA et al (2013) Combined Hepatocellular and Cholangiocarcinoma (Biphenotypic) Tumors: Imaging Features and Diagnostic Accuracy of Contrast-Enhanced CT and MRI. Am J Roentgenol 201:332–339

    Article  Google Scholar 

  14. Maximina S, Ganeshane DM, Shanbhogued AK et al (2014) Current update on combined hepatocellular-cholangiocarcinoma. Eur J of Radiol Open 1:40–48

    Article  Google Scholar 

  15. de Campos RO, Semelka RC, Azevedo RM et al (2012) Combined Hepatocellular Carcinoma-Cholangiocarcinoma: Report of MR Appearance in Eleven Patients. J Magn Reson Imaging 36:1139–1147

    Article  PubMed  Google Scholar 

  16. Potretzke TA, Tan BR, Doyle MB, Brunt EM, Heiken JP, Fowler KJ (2016) Imaging features of biphenotypic primary liver carcinoma (hepatocholangiocarcinoma) and the potential to mimic hepatocellular carcinoma: LIRADS analysis of CT and MRI features in 61 cases. AJR 207:25–31

    Article  PubMed  Google Scholar 

  17. Kim R, Lee JM, Shin C-I et al (2016) Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol 26:1808–1817

    Article  PubMed  Google Scholar 

  18. Ganeshan D, Szklaruk J, Kundra V, Rashid AK, Elsayesl KM (2014) Imaging Features of Fibrolamellar Hepatocellular Carcinoma. Am J Roentgenol 202:544–552

    Article  Google Scholar 

  19. Smith MT, Blatt ER, Paul Jedlicka P, Strain JD, Fenton LZ (2008) Fibrolamellar Hepatocellular Carcinoma. Radiographics 28:609–613

    Article  PubMed  Google Scholar 

  20. Ichicava T, Federle MP, Grazioli L, Madariaga J, Nelesnik M, Marsh W (1999) Fibrolamellar hepatocellular carcinoma: Imaging and pathologic findings in 31 recent cases. Radiology 213:352–361

    Article  Google Scholar 

  21. Paolantonio P, Laghi A, Vanzulli A et al (2014) MRI of Hepatic Epithelioid Hemangioendothelioma (HEH). J Magn Reson Imaging 40:552–558

    Article  PubMed  Google Scholar 

  22. Lin J, Ji Y (2010) CT and MRI diagnosis of hepatic epithelioid hemangioendothelioma. Hepatobiliary Pancreat Dis Int. 9:154–158

    PubMed  Google Scholar 

  23. Gan L, Chang R, Jin H, Yang L (2016) Typical CT and MRI signs of hepatic epitheloid hemangioendothelioma. Oncol Lett 11:1699–1706

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Giardino A, Miller FH, Kalb B et al (2016) Hepatic epithelioid hemangioendothelioma: a report from three university centers. Radiol Bras 49:288–294

    Article  PubMed  PubMed Central  Google Scholar 

  25. Iqbal K, Xian ZM, Yuan C (2008) Undifferentiated liver sarcoma – rare entity: a case report and review of the literature. J Medical Case Rep 2:20

    Article  Google Scholar 

  26. Tsukada A, Ishizaki Y, Nobukawa B, Kawasaki S (2010) Embryonal Sarcoma of the Liver in an Adult Mimicking Complicated Hepatic Cyst: MRI Findings. J Magn Reson Imaging 31:1477–1480

    Article  PubMed  Google Scholar 

  27. Yu R-S, Chen Y, Jiang B, Wang L-H, Xu X-F (2008) Primary hepatic sarcomas: CT findings. Eur Radiol 18:2196–2205

    Article  PubMed  Google Scholar 

  28. Thapar S, Rastogi A, Ahuja A, Sarin S (2014) Angiosarcoma of the liver: imaging of a rare salient entity. J Radiol Case Rep 8:24–32

    PubMed  PubMed Central  Google Scholar 

  29. Kumasaka S, Okauchi K, Taketomi AT, et al. (2014) Angiosarcoma: Review of CT and MR Imaging features. Abstract. European Congress of Radiology Meeting

  30. Koyama T, Fletcher JG, Johnson CD et al (2002) Primary Hepatic Angiosarcoma: Findings at CT and MR Imaging. Radiology 222:667–673

    Article  PubMed  Google Scholar 

  31. Matos AP, Jeon YH, Ramalho M, AlObaidy M, Semelka RC (2016) Lobulated margination of liver hemangiomas: Is this a definitive feature? Clin Imaging 40:801–805

    Article  PubMed  Google Scholar 

  32. Rajesh S, Bansal K, Sureka B, Patidar Y, Bihari C, Arora A (2015) The imaging conundrum of hepatic lymphoma revisited. Insights Imaging 6:679–692

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Maher MM, Mcdermott SR, Fenlon HM et al (2001) Imaging of Primary Non-Hodgkin's Lymphoma of the Liver. Clinical Radiology 56:295–301

    Article  CAS  PubMed  Google Scholar 

  34. Steller EJA, Leeuwen MSV, Hillegersberg RV et al (2012) Primary lymphoma of the liver: A complex diagnosis. World J Radiol 4:53–57

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kelekis NL, Semelka RC, Siegelman ES et al (1997) Focal hepatic lymphoma: Magnetic resonance demonstration using current techniques including gadolinium enhancement. Magn Reson Imaging 15:625–636

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA

    Richard C. Semelka, Nadesan Nimojan, Saman Chandana & Ersan Altun

  2. Department of Radiology, Hospital Garcia de Orta, EPE, Almada, Portugal

    Miguel Ramalho

  3. Department of Radiology, University of South California, Los Angeles, CA, USA

    Suzanne L. Palmer & Bonnie L. Garon

  4. Department of Radiology, Georgetown University, Washington, DC, USA

    Danielle DeMulder & Reena C. Jha

  5. Department of Radiology, Northwestern University, Chicago, IL, USA

    Carolina Parada Villavicencio & Frank H. Miller

  6. Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    John Woosley

Authors
  1. Richard C. Semelka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nadesan Nimojan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saman Chandana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miguel Ramalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Suzanne L. Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Danielle DeMulder
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carolina Parada Villavicencio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John Woosley
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bonnie L. Garon
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Reena C. Jha
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Frank H. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ersan Altun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ersan Altun.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Ersan Altun, M.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Boards.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional/observational study

• multicentre study

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Semelka, R.C., Nimojan, N., Chandana, S. et al. MRI features of primary rare malignancies of the liver: A report from four university centres. Eur Radiol 28, 1529–1539 (2018). https://doi.org/10.1007/s00330-017-5102-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-017-5102-7

Keywords

Search

Navigation