Epithelioid Hemangioendothelioma of the Liver: Helical CT Findings

Lee, Jongmee; Lee, Won Jae; Lim, Hyo K; Choi, Dongil; Kim, Seong Hyun; Lee, Soon Jin; Lim, Jae Hoon; Lee, Ji Yeon; Cho, Jae Min; Lee, Min Hee; Han, Boo Kyung

Abstract

PURPOSE: To describe the morphologic features and enhancement patterns of the helical computed tomography (CT) observed in patients with epithelioid hemangioendothelioma (EH) of the liver.
MATERIALS AND METHODS
Seven patients (four men and three women; mean age, 41 years) with pathologically proven EHs underwent monophasic (n=2), biphasic (n=2) or triphasic (n=3) helical CT, and the findings were retrospectively analysed. The morphologic features to which attention was directed were tumor number, size, location, shape, margin, surface, the presence of adjacent capsular retraction, vascular encasement and confluent mass formation, while the enhancement pattern was examined in terms of the appearance and degree of enhancement during the arterial or portal phase, and enhancement change during the portal and equilibrium phases.
RESULTS
Six patients had multiple tumors, and one had a single lesion. The maximon diameter of these tumors ranged from 0.5 to 12.0 (mean, 3.2) cm, and almost all occurred in the peripheral portion of the liver. The shape, margin and surface features of the tumors varied: in four patients, the margin was poorly defined and the surface was smooth, while in five, adjacent capsular retraction was observed. Vascular encasement was noted in five of six patients with hepatic vessels abutting the tumors, and in all three who were follow up, the growth pattern involved confluent mass formation. In all patients, many tumors showed either nodular (n=3) or irregular (n=4) peripheral enhancement. In all five patients who underwent multiphasic CT, centripetal enhancement was demoustrated.
CONCLUSION
Our results disclosed that most patients with EH had multiple tumors, and that almost all were located in the peripheral portion of the liver and involved capsular retraction. The other common CT findings were vascular encasement and a centripetal enhancement pattern. When these CT findings are observed in patients with hepatic tumors, EH should be included in the differential diagnosis.