Radiologic-pathologic comparison of undifferentiated embryonal sarcoma of the liver in a 61-year-old woman

Abstract

Undifferentiated(embryonal) sarcoma;Liver;Adult;Anatomical/pathologicalcorrelationMrs. V, a 61-year-old woman with no particular history, was seen for impairment ofgeneral health and abdominal pain. The physical examination found a tender mass inthe right hypochondrium. The laboratory tests revealed presence of inflammation(CRP: 350mg/L, 15,000 neutrophils), cytolysis (ALT: 130IU/L, AST: 150IU/L: 4N), anictericcholestasis (alkaline phosphatase: 450IU/L); tumor markers AFP (8ng/mL) and CA 125(27 U/mL) were normal.The ultrasound (Fig. 1a, b) showed a voluminous hypo-hyperechoic heterogenous solidhepatic mass that had developed to the detriment of segment IV (19 ×25 21mm), andresponsible for dilatation of the left intrahepatic bile ducts. On the CT scan, it was tissular,heterogeneous, andcompartmentalized,presentedhemorrhagicchanges,andhadarteriesrunning through it (Fig. 1 c, d). After injection, moderate enhancement was seen in thearterial phase, increasing in the delayed phase. The hepatic parenchyma was normal; thestaging was negative.On the MRI (Fig. 2), the lesion was clearly hyperintense on the T2-weighted imageswith multiple walls and cavities of varying sizes. After injection, homogeneous peripheralenhancement was seen with uptake by the septa, but not central enhancement.The surgicalresection,whichwasperformedquicklyduetotheimpairedgeneralhealth,confirmed the cystic, encapsulated intrahepatic mass (Fig. 3a, b) centered in segmentIV. The resection was complete. The surgical specimen weighed 3550g and measured27 ×22×10cm. It was composed of multiple cavities of varying size with a necrotic