European Radiology

, 18:2196 | Cite as

Primary hepatic sarcomas: CT findings

  • Ri-Sheng Yu
  • Ying Chen
  • Biao Jiang
  • Liu-Hong Wang
  • Xiu-Fang Xu


Primary hepatic sarcomas are rare tumors that are difficult to diagnose clinically. Different primary hepatic sarcomas may have different clinical, morphologic, and radiological features. In this pictorial review, we summarized computed tomography (CT) findings of some relatively common types of hepatic sarcomas, including angiosarcoma, epithelioid hemangioendothelioma (EHE), liposarcoma, undifferentiated embryonal sarcoma (UES), leiomyosarcoma, malignant fibrous histiocytoma (MFH), and carcinosarcoma (including cystadenocarcinosarcoma). To our knowledge, hepatic cystadenocarcinosarcoma has not been described in the English literature. The CT findings in our case are similar to that of cystadenocarcinoma, a huge, multilocular cystic mass with a large mural nodule and solid portion. The advent of CT has allowed earlier detection of primary hepatic sarcomas as well as more accurate diagnosis and characterization. In addition, we briefly discuss the MRI findings and diagnostic value of primary hepatic sarcomas.


Liver neoplasms Sarcoma Computed tomography-CT 


  1. 1.
    Weitz J, Klimstra DS, Cymes K, Jarnagin WR, D’Angelica M, La Quaglia MP, Fong Y, Brennan MF, Blumgart LH, Dematteo RP (2007) Management of primary liver sarcomas. Cancer 109:1391–1396PubMedCrossRefGoogle Scholar
  2. 2.
    Nelson V, Fernandes NF, Woolf GM, Geller SA, Petrovic LM (2001) Primary liposarcoma of the liver: a case report and review of literature. Arch Pathol Lab Med 125:410–412PubMedGoogle Scholar
  3. 3.
    Gates LK Jr, Cameron AJ, Nagorney DM, Goellner JR, Farley DR (1995) Primary leiomyosarcoma of the liver mimicking liver abscess. Am J Gastroenterol 90:649–652PubMedGoogle Scholar
  4. 4.
    Buetow PC, Buck JL, Pantongrag-Brown L, Marshall WH, Ros PR, Levine MS, Goodman ZD (1997) Undifferentiated (embryonal) sarcoma of the liver: pathologic basis of imaging findings in 28 cases. Radiology 203:779–783PubMedGoogle Scholar
  5. 5.
    Molina E, Hernandez A (2003) Clinical manifestations of primary hepatic angiosarcoma. Dig Dis Sci 48:677–682PubMedCrossRefGoogle Scholar
  6. 6.
    Lao XM, Chen DY, Zhang YQ, Xiang J, Guo RP, Lin XJ, Li JQ (2007) Primary carcinosarcoma of the liver: clinicopathologic features of 5 cases and a review of the literature. Am J Surg Pathol 31:817–826PubMedCrossRefGoogle Scholar
  7. 7.
    Koyama T, Fletcher JG, Johnson CD, Kuo MS, Notohara K, Burgart LJ (2002) Primary hepatic angiosarcoma: findings at CT and MR Imaging. Radiology 222:667–673PubMedCrossRefGoogle Scholar
  8. 8.
    Fracanzani AL, Conte D, Fraquelli M, Taioli E, Mattioli M, Losco A, Fargion S (2001) Increased cancer risk in a cohort of 230 patients with hereditary hemochromatosis in comparison to matched control patients with non-iron-related chronic liver disease. Hepatology 33:647–651PubMedCrossRefGoogle Scholar
  9. 9.
    Kojiro M, Nakashima T, Ito Y, Ikezaki H, Mori T, Kido C (1985) Thorium dioxide-related angiosarcoma of the liver: pathomorphologic study of 29 autopsy cases. Arch Pathol Lab Med 109:853–857PubMedGoogle Scholar
  10. 10.
    Buetow PC, Buck JL, Ros PR, Goodman ZD (1994) Malignant vascular tumours of the liver: radiologic-pathologic correlation. Radiographics 14:153–166PubMedGoogle Scholar
  11. 11.
    Ikeda K, Maehara M, Ohmura N, Kurokawa H, Koda K, Yokoyama H, Sawada S (2006) Spontaneous rupture of a necrotic hepatic angiosarcoma: findings on dual-phase computed tomography and angiography. Radiat Med 24:369–372PubMedCrossRefGoogle Scholar
  12. 12.
    White PG, Adams H, Smith PM (1993) The computed tomographic appearances of angiosarcoma of the liver. Clin Radiol 48:321–325PubMedCrossRefGoogle Scholar
  13. 13.
    Peterson MS, Baron RL, Rankin SC (2000) Hepatic angiosarcoma: findings on multiphasic contrast-enhanced helical CT do not mimic hepatic hemangioma. AJR Am J Roentgenol 175:165–170PubMedGoogle Scholar
  14. 14.
    Rademaker J, Widjaja A, Galanski M (2000) Hepatic hemangiosarcoma: imaging findings and differential diagnosis. Eur Radiol 10:129–133PubMedCrossRefGoogle Scholar
  15. 15.
    Heo SH, Jeong YY, Shin SS, Chung TW, Kang HK (2007) Solitary small hepatic angiosarcoma: initial and follow-up imaging findings. Korean J Radiol 8:180–183PubMedCrossRefGoogle Scholar
  16. 16.
    Weiss SW, Enzinger FM (1982) Epithelioid hemangioendothelioma: a vascular tumor often mistaken for carcinoma. Cancer 50:970–981PubMedCrossRefGoogle Scholar
  17. 17.
    Earnest F 4th, Johnson CD (2006) Case 96: Hepatic epithelioid hemangioendothelioma. Radiology 240:295–298PubMedCrossRefGoogle Scholar
  18. 18.
    Lyburn ID, Torreggiani WC, Harris AC, Zwirewich CV, Buckley AR, Davis JE, Chung SW, Scudamore CH, Ho SG (2003) Hepatic epithelioid hemangioendothelioma: sonographic CT and MR imaging appearances. AJR Am J Roentgenol 180:1359–1364PubMedGoogle Scholar
  19. 19.
    Makhlouf HR, Ishak KG, Goodman ZD (1999) Epithelioid hemangioendothelioma of the liver: a clinicopathologic study of 137 cases. Cancer 85:562–582PubMedCrossRefGoogle Scholar
  20. 20.
    Miller WJ, Dodd GD 3rd, Federle MP, Baron RL (1992) Epithelioid hemangioendothelioma of the liver: imaging findings with pathologic correlation. AJR Am J Roentgenol 159:53–57PubMedGoogle Scholar
  21. 21.
    Radin DR, Craig JR, Colletti PM, Ralls PW, Halls JM (1988) Hepatic epithelioid hemangioendothelioma. Radiology 169:145–148PubMedGoogle Scholar
  22. 22.
    Furui S, Itai Y, Ohtomo K, Yamauchi T, Takenaka E, Iio M, Ibukuro K, Shichijo Y, Inoue Y (1989) Hepatic epithelioid hemangioendothelioma: report of five cases. Radiology 171:63–68PubMedGoogle Scholar
  23. 23.
    Murphey MD, Arcara LK, Fanburg-Smith J (2005) From the archives of the AFIP: imaging of musculoskeletal liposarcoma with radiologic-pathologic correlation. Radiographics 25:1371–1395PubMedCrossRefGoogle Scholar
  24. 24.
    Unal B, Bilgili YK, Batislam E, Erdogan S (2004) Giant dedifferentiated retroperitoneal liposarcoma: CT and MRI findings. Eur J Radiol Extra 51:47–50CrossRefGoogle Scholar
  25. 25.
    Kim JL, Woo JY, Lee MJ, Kim KR, Jung JP, Lee NJ, Choi SH, Kim HD, Yang I, Chung SY (2007) Imaging findings of primary well-differentiated liposarcoma of the liver: a case report. Acta Radiol 48:1061–1065PubMedCrossRefGoogle Scholar
  26. 26.
    Aribal E, Berberoglu L (1993) Primary liposarcoma of the liver. AJR Am J Roentgenol 161:1331–1332PubMedGoogle Scholar
  27. 27.
    Kuo LM, Chou HS, Chan KM, Yu MC, Lee WC (2006) A case of huge primary liposarcoma in the liver. World J Gastroenterol 12:1157–1159PubMedGoogle Scholar
  28. 28.
    Khan A, Sherlock DJ, Wilson G, Butterworth D (2001) Sonographic appearance of primary liver liposarcoma. J Clin Ultrasound 29:44–47PubMedCrossRefGoogle Scholar
  29. 29.
    Francis IR, Cohan RH, Varma DG, Sondak VK (2005) Retroperitoneal sarcomas. Cancer Imaging 5:89–94PubMedCrossRefGoogle Scholar
  30. 30.
    Ferrozzi F, Bova D, Zangrandi A, Garlaschi G (1996) Primary liver leiomyosarcoma: CT appearance. Abdom Imaging 21:157–160PubMedCrossRefGoogle Scholar
  31. 31.
    Brichard B, Smets F, Sokal E, Clapuyt P, Vermylen C, Cornu G, Rahier J, Otte JB (2001) Unusual evolution of an Epstein-Barr virus-associated leiomyosarcoma occurring after liver transplantation. Pediatr Transplant 5:365–369PubMedCrossRefGoogle Scholar
  32. 32.
    Soyer P, Bluemke DA, Riopel M, Hruban RH, Fishman EK (1995) Hepatic leiomyosarcomas: CT features with pathologic correlation. Eur J Radiol 19:177–182PubMedCrossRefGoogle Scholar
  33. 33.
    Fujita H, Kiriyama M, Kawamura T, Ii T, Takegawa S, Dohba S, Kojima Y, Yoshimura M, Kobayashi A, Ozaki S, Watanabe K (2002) Primary hepatic leiomyosarcoma in a woman after renal transplantation: report of a case. Surg Today 32:446–449PubMedCrossRefGoogle Scholar
  34. 34.
    Ohtomo K, Araki T, Itai Y, Monzawa S, Ohba H, Nogata Y, Hihara T, Koizumi K, Uchiyama G (1992) MR imaging of malignant mesenchymal tumors of the liver. Gastrointest Radio1 17:58–62CrossRefGoogle Scholar
  35. 35.
    Soyer P, Blanc F, Vissuzaine C, Marmuse JP, Menu Y (1996) Primary leiomyosarcoma of the liver MR findings. Clin Imaging 20:273–275PubMedCrossRefGoogle Scholar
  36. 36.
    Wang XW, Liang P, Li HY (2004) Primary hepatic carcinosarcoma: a case report. Chin Med J 117:1586–1587PubMedGoogle Scholar
  37. 37.
    Kwon JH, Kang YN, Kang KJ (2007) Carcinosarcoma of the liver: a case report. Korean J Radiol 8:343–347PubMedCrossRefGoogle Scholar
  38. 38.
    Rummeny E, Weissleder R, Stark DD, Saini S, Compton CC, Bennett W, Hahn PF, Wittenberg J, Malt RA, Ferrucci JT (1989) Primary liver tumors: diagnosis by MR imaging. AJR Am J Roentgenol 152:63–72PubMedGoogle Scholar
  39. 39.
    Kim HG (2006) Biliary cystic neoplasm: biliary cystadenoma and biliary cystadenocarcinoma. Korean J Gastroenterol 47:5–14PubMedGoogle Scholar
  40. 40.
    Mortele KJ, Ros PR (2001) Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics 21:895–910PubMedGoogle Scholar
  41. 41.
    Ding GH, Wu MC, Yang JH, Cheng SQ, Li N, Liu K, Dai BH, Cong WM (2006) Primary hepatic malignant fibrous histiocytoma mimicking cystadenocarcinoma: a case report. Hepatobiliary Pancreat Dis Int 5:620–623PubMedGoogle Scholar
  42. 42.
    Anagnostopoulos G, Sakorafas GH, Grigoriadis K, Kostopoulos P (2005) Malignant fibrous histiocytoma of the liver: a case report and review of the literature. Mt Sinai J Med 72:50–52PubMedGoogle Scholar
  43. 43.
    Yu JS, Kim KW, Kim CS, Yoon KH, Jeong HJ, Lee DG (1999) Primary malignant fibrous histiocytoma of the liver: imaging features of five surgically confirmed cases. Abdom Imaging 24:386–391PubMedCrossRefGoogle Scholar
  44. 44.
    Ferrozzi F, Bova D (1998) Hepatic malignant fibrous histiocytoma: CT findings. Clin Radiol 53:699–701PubMedCrossRefGoogle Scholar
  45. 45.
    Wunderbaldinger P, Schima W, Harisinghani M, Saini S (1998) Primary malignant fibrous histiocytoma of the liver: CT and MR findings. AJR Am J Roentgenol 171:900–901PubMedGoogle Scholar
  46. 46.
    Reed JG, Goodman P, Soloway RD (1993) Primary malignant fibrous histiocytoma of the liver MRI findings. Magn Reson Imaging 11:139–143PubMedCrossRefGoogle Scholar
  47. 47.
    Stocker JT, Ishak KG (1978) Undifferentiated (embryonal) sarcoma of the liver: Report of 31 cases. Cancer 42:336–348PubMedCrossRefGoogle Scholar
  48. 48.
    Sakellaridis T, Panagiotou I, Georgantas T, Micros G, Rontogianni D, Antiochos C (2006) Undifferentiated embryonal sarcoma of the liver mimicking acute appendicitis. Case report and review of the literature. World J Surg Oncol 4:9PubMedCrossRefGoogle Scholar
  49. 49.
    Dai CL, Xu F, Shu H, Xu YQ, Huang Y (2005) Undifferentiated (embryonal) sarcoma of liver in adult: a case report. World J Gastroenterol 11:926–929PubMedGoogle Scholar
  50. 50.
    Bisogno G, Pilz T, Perilongo G, Ferrari A, Harms D, Ninfo V, Treuner J, Carli M (2002) Undifferentiated sarcoma of the liver in childhood: a curable disease. Cancer 94:252–257PubMedCrossRefGoogle Scholar
  51. 51.
    Buetow PC, Rao P, Marshall WH (1997) Imaging of pediatric liver tumors. Magn Reson Imaging Clin N Am 5:397–413PubMedGoogle Scholar
  52. 52.
    Yoon W, Kim JK, Kang HK (1997) Hepatic undifferentiated embryonal sarcoma: MR findings. J Comput Assist Tomogr 21:100–102PubMedCrossRefGoogle Scholar
  53. 53.
    Psatha EA, Semelka RC, Fordham L, Firat Z, Woosley JT (2004) Undifferentiated (embryonal) sarcoma of the liver (USL): MRI findings including dynamic gadolinium enhancement. Magn Reson Imaging 22:897−900PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  • Ri-Sheng Yu
    • 1
  • Ying Chen
    • 1
  • Biao Jiang
    • 1
  • Liu-Hong Wang
    • 1
  • Xiu-Fang Xu
    • 2
  1. 1.Department of Radiology, the Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
  2. 2.Teaching and Research Group of RadiologyZhejiang Medical CollegeHangzhouChina

Personalised recommendations