Three cases of histologically proven hepatic epithelioid hemangioendothelioma evaluated using a second-generation microbubble contrast medium in ultrasonography: case reports
Three cases of histologically proven hepatic epithelioid hemangioendothelioma evaluated using a second-generation microbubble contrast medium in ultrasonography: case reports
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DOI：
10.1186/s12876-019-1113-y
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发表时间：
2019-11-14
影响因子：
2.4
通讯作者：
Yoshida, Hitoshi
中科院分区：
文献类型：
--
作者：
Arai, Jun;Shimozuma, Yuu;Yoshida, Hitoshi
肝上皮样血管内皮瘤（HEH）是一种罕见的疾病，据报道，每100万例患者中有1例。为了准确诊断，需要关于HEH中多种图形模式的信息。然而，关于Sonazoid（R）超声造影（CEUS）在HEH中的信息非常少。病例介绍本报告描述了使用Sonazoid（R）CEUS评价的三例经组织学证实的HEH病例。病例1是一名33岁女性患者，无相关既往病史，出现右上腹疼痛。常规腹部超声显示多个边界模糊的低回声肝结节。在CEUS中，结节的血管分布与邻近的正常肝脏相似。随后在门静脉和晚期（PVLP）和血管后阶段，在结节中检测到Sonazoid（R）的洗脱。病例2为一名93岁女性患者，既往病史包括50多岁时接受过乳腺癌和卵巢癌手术。常规腹部超声显示多发低回声结节，其中一些包含囊性病变。在CEUS的早期血管相，除了中央无回声区以外的结节从周围部位增强。虽然结节内部在PVLP期和血管后期均持续增强，但部分结节中心无回声区完全不增强。病例3是一名39岁男性患者，表现为右上腹疼痛，无任何相关既往病史。常规腹部超声显示多个低回声肝结节。CEUS血管相早期，结节自周围逐渐增强，呈环形强化。在PVLP和血管后阶段，从结节中冲洗出Sonazoid（R）。结论早期血管期以周边强化为主。在病例2中，即使在PVLP中，肝结节的实质增强也持续存在;表明恶性潜能的程度低于其他病例。实际上，在病例2中，肿瘤在没有任何治疗的情况下没有扩展。由于病例2是第一例伴有囊性病变的HEH病例报告，因此在伴有包括囊性病变的肝结节患者中，HEH是一种潜在的诊断。
Background Hepatic epithelioid hemangioendothelioma (HEH) is rare; it is reported in < 1 person in 1,000,000 individuals. For accurate diagnosis, information regarding multiple graphic modalities in HEH is required. However, there is very little information concerning Sonazoid (R) contrast enhanced ultrasonography (CEUS) in HEH. Case presentation The present report describes the histologically proven three HEH cases evaluated using Sonazoid (R) CEUS. Case 1 was a 33-year-old female patient with no relevant past medical history, who experienced right upper quadrant pain. Conventional abdominal US revealed multiple low echoic liver nodules with vague borderlines. In CEUS, the vascularity of the nodules was similar to that seen in the neighboring normal liver. Later in the portal venous and late phases (PVLP) and post vascular phase, washout of Sonazoid (R) was detected in the nodules. Case 2 was a 93-year-old female patient with a previous medical history including operations for breast cancer and ovary cancer in her 50's. Conventional abdominal US revealed multiple low echoic nodules, some of which contained cystic lesions. In the early vascular phase of CEUS, nodules excluding the central anechoic regions were enhanced from peripheral sites. Although the enhancement inside the nodules persisted in both the PVLP and post vascular phase, anechoic areas in the center of some nodules were not enhanced at all. Case 3 was a 39-year-old male patient presented with right upper-quadrant pain, without any relevant past medical history. Conventional abdominal US revealed multiple low echoic liver nodules. In the early vascular phase of CEUS, nodules were gradually enhanced from the peripheral sites as ringed enhancement. Sonazoid (R) was washed out from the nodules in the PVLP and post vascular phase. Conclusions The most important feature was peripheral enhancement in the early vascular phase. In case 2, the enhancement of the parenchyma of liver nodules persisted even in the PVLP; indicating the lower degree of malignant potential than others. Actually, the tumors did not extend without any treatment in case 2. Since case 2 is the first case report of HEH with cystic lesions, in patients with liver nodules including cystic lesions, HEH is a potential diagnosis.