A previously healthy 60-year-old woman presented to the hospital with 2 weeks of dull
pain in the right upper quadrant and intermittent nausea. On admission her hepatitis
B surface antigen was positive, serum alpha-foetoprotein (8 ng/ml), carbohydrate antigen
125 (10.3 U/ml), carbohydrate antigen 199 (9.9 U/ml) and liver function were within
the normal range. Magnetic resonance imaging (MRI) showed a solitary lesion measuring
39 mm × 40 mm × 54 mm in Segment VIII of the liver. It demonstrated an unusual multi-layered
target appearance resembling a “maze”. On diffusion-weighted image (DWI) the mass
surprisingly showed six layers with alternate high and low signals (Fig. 1a), while on T2-weighted image (T2WI) five layers can be seen (Fig. 1b). The lesion didn't demonstrate as many layers on T1WI, however a target appearance
was still recognizable (Fig. 1c). On Gd-EOB-DTPA enhanced MRI, the lesion showed progressive rim enhancement on
the arterial and portal venous phase (Fig. 1d, e), and appeared as a low signal target with a distinct hypointense core on the
hepatobiliary phase (Fig. 1f). Initial diagnosis included hepatocellular carcinoma, cholangiocarcinoma, or metastasis.
The patient underwent biopsy and histopathology confirmed hepatic epithelioid hemangioendothelioma
(HEHE). Immunohistochemical staining showed positive for CD34 and CD31 (Fig. 1g, h).
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References
- Imaging findings in epithelioid hemangioendothelioma.Clin Imaging. 2019; 58: 59-65
- MRI of hepatic epithelioid hemangioendothelioma (HEH).J Magn Reson Imaging. 2014; 40: 552-558
- Hepatic Hemangioendothelioma: an update.World J Gastrointest Oncol. 2020; 12: 248-266
Article info
Publication history
Published online: April 03, 2022
Accepted:
March 30,
2022
Received:
August 14,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
