Abstract
BackgroundComparisons of hepatic epithelioid hemangioendothelioma (HEHE), hepatic hemangioma, and hepatic angiosarcoma (HAS) have rarely been reported. The purpose of our study was to analyze the clinical and magnetic resonance imaging (MRI) findings of these conditions.MethodsA total of 57 patients (25 with hemangioma, 13 with HEHE, and 19 with HAS) provided hepatic vascular endothelial cell data between June 2006 and May 2017.ResultsThe proportions of cases with circumscribed margins were 88% (22/25), 84.6% (11/13), and 31.6% (6/19) for hemangioma, HEHE, and HAS, respectively (P < 0.001). HAS lesions were less likely to have circumscribed margins. The proportions of lesions with hemorrhaging were 4% (1/25), 30.8% (4/13), and 36.8% (7/19) for hemangioma, HEHE, and HAS, respectively (P = 0.014). HEHE and HAS cases were more likely to show heterogeneous signals on T1-weighted (T1WI) MRI. HEHE and HAS cases were more likely to show heterogeneous signals on T2-weighted (T2WI) MRI. Centripetal enhancement was the most common pattern in vascular tumors, with proportions of 100, 46.2% (6/13), and 68.4% (13/19) for hemangioma, HEHE, and HAS, respectively. The difference in enhancement pattern between HEHE and HAS was not significant, but rim enhancement was more common for HEHE (46.2%, 6/13).ConclusionsOur study revealed clinical and imaging differences between HEHE and HAS. The platelet count (PLT) and coagulation function of the HAS group decreased, whereas the alpha-fetoprotein (AFP) level increased. The 5-year survival rate for HAS was significantly lower than that of HEHE. A higher malignancy degree indicated a more blurred lesion margin, easier occurrence of hemorrhaging, and more heterogeneous T1WI and T2WI signals.
Highlights
Comparisons of hepatic epithelioid hemangioendothelioma (HEHE), hepatic hemangioma, and hepatic angiosarcoma (HAS) have rarely been reported
Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomographic PET-CT have been reported in the diagnosis of HEHE and HAS [8,9,10,11,12] in a few cases [10, 11, 13]
This study included 57 patients with tumors derived from hepatic vascular endothelial cells: 25 with hemangioma, 13 with HEHE, and 19 with HAS
Summary
Comparisons of hepatic epithelioid hemangioendothelioma (HEHE), hepatic hemangioma, and hepatic angiosarcoma (HAS) have rarely been reported. Liver-derived vascular endothelial cells can cause angiogenic lesions, including those that are benign (hepatic hemangioma), low-grade (hepatic epithelioid hemangioendothelioma, HEHE), or malignant (hepatic angiosarcoma, HAS). HEHE and HAS are rare and poorly understood liver malignancies [5,6,7] with low incidences. Their preoperative diagnoses require invasive puncture, which can lead to complications such as hemorrhaging and biliary fistula. Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomographic PET-CT have been reported in the diagnosis of HEHE and HAS [8,9,10,11,12] in a few cases [10, 11, 13]. The 5-year survival rate of HAS is significantly lower than those of HEHE and hemangioma
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