Contrast-enhanced Ultrasound of Undifferentiated Embryonal Sarcoma of the Liver in Adult: Two Cases Report and Literature Review

doi:10.37015/AUDT.2022.220014

Abstract

Abstract:

Undifferentiated embryonal sarcoma of the liver (UESL) is an aggressive mesenchymal tumor, which presents a low incidence in adults. The low morbidity and atypical clinical manifestations conduce to difficulty in preoperative diagnosis. Imaging manifestations of this tumor is important for its identification. Contrast-enhanced ultrasound (CEUS) was a promising tool to characterize hepatic lesions and proved to have high diagnostic accuracy. The present study reported the CEUS characteristics of UESL in two adult patients, which exhibited peripheral rim hyper-enhancement along with progressively centripetal enhancement and large areas of perfusion defection. Sonographers should be fully aware of this rare disease for better differential diagnosis.

Key words: Contrast-enhanced ultrasound; Undifferentiated embryonal sarcoma of the liver; Diagnosis; Case report

Yanling Chen, MM, Hantao Wang, MM, Hong Han, PhD, Yi Dong, PhD, Wen-ping Wang, MD. Contrast-enhanced Ultrasound of Undifferentiated Embryonal Sarcoma of the Liver in Adult: Two Cases Report and Literature Review. Advanced Ultrasound in Diagnosis and Therapy, 2022, 6(4): 204-209.

Figures/Tables 3

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Liver neoplasms	Symptoms	Laboratory test/tumor markers	B-mode ultrasound	Contrast-enhanced ultrasound
Liver neoplasms	Symptoms	Laboratory test/tumor markers	B-mode ultrasound	Arterial phase	Portal venous phase	Late phase
Undifferentiated embryonal sarcoma of the liver	Abdominal mass, abdominal pain, fever, nausea, weight lost, et al.	Normal /TBL, ALT, AST, AKP, γ-GGT, et al.	A heterogeneous echogenic cystic-solid mass with well-defined boundary and irregular shape; Maximum diameter more than 10 cm	Peripheral rim hyperenhancement along with progressively centripetal enhancement; Large areas of perfusion defection within the lesion	Iso-enhancement or sightly hypo-enhancement	Iso-enhancement or sightly hypo-enhancement
Liver abscess	Abdominal pain, hyperthermia, chills, nausea, vomiting, et al.	WBC; ESR; CRP	A cystic mass with honeycomb-like necrotic areas	Rim enhancement; No enhancement or honeycomb-like enhancement in the center	The ring-enhancing part gradually become hypo-enhancement	Slightly hypo-enhancement
Intrahepatic cholangiocarcinoma	Abdominal mass, abdominal pain, fatigue, weakness, jaundice, weight lost, et al.	CA19-9; AFP; TBL, ALT, AST, AKP, γ-GGT, et al.	Hypoechoic, isoechoic, or hyperechoic mass with ill-defined boundary and irregular shape; Biliary ductal dilatation; Metastasis; Vascular invasion	Rim-like enhancement; Heterogeneous hyperenhancement; Homogeneous hyperenhancement	Significant hypo-enhancement	Non-enhancement
Hemangiosarcoma	Abdominal pain, fever, anorexia, fatigue, weight loss, et al.	Normal	Hypoechoic mass with ill-defined boundary	Nodular peripheral enhancement or peripheral rim-like enhancement; Central non-enhancement	Peripheral enhancement declined gradually	Hypo-enhancement