Liver Update Meeting Nottingham Nov 14 2006 Case Presentation - - PowerPoint PPT Presentation

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Liver Update Meeting Nottingham Nov 14 2006 Case Presentation - - PowerPoint PPT Presentation

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Liver Update Meeting Nottingham Nov 14 2006 Case Presentation Female, born 1978 Presented in 2002 with multiple liver lesions ?nature Oral contraceptive pill use. No other medical history Liver biopsy fibrosis?cause Liver

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Liver Update Meeting – Nottingham Nov 14 2006 Case Presentation Female, born 1978 Presented in 2002 with multiple liver lesions ?nature Oral contraceptive pill use. No other medical history Liver biopsy – fibrosis?cause Liver transplantation September 2003

  • 13 ill-defined masses throughout liver
  • 1-6cm in maximum dimension
  • firm, white
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Is this process reactive or neoplastic?

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CD 31

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CD 31

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BS cytokeratin

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BS cytokeratin

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Ki 67

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Diagnosis Epithelioid haemangioendothelioma

Liver Update Meeting – Nottingham Nov 14 2006

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1. Characteristic “zonation” (Dietze 1989)

  • highest cellularity at periphery
  • tectorial growth pattern along sinusoids
  • intravascular “sprouts”
  • obliteration of sinusoids and vessels leads to increasing fibrosis centrally , myxoid

stroma, scanty tumour cells

2. Usually multifocal (>80% of cases, both lobes)

  • implications for surgical resection
  • lung commonest extrahepatic site of involvement ? metastatic, ? multifocal

primary neoplasms

3. Behaviour unpredictable

  • low grade malignancy (45-55 % 5 year survival)
  • cellularity, necrosis associated with poor outcome (Makhlouf 1999)

4. Differential Diagnosis

  • reactive conditions with zonal fibrosis (including Budd-Chiari syndrome)
  • other neoplasms (esp sclerosing carcinoma)

Makhlouf HR, Ishak KG, Goodman ZD. Epithelioid hemangioendothelioma of the liver: a clinicopathologic study of 137 cases. Cancer. 1999; 85:562-82. Mehrabi et al. Primary malignant hepatic epithelioid hemangioendothelioma: a comprehensive review of the literature with emphasis on the surgical therapy. : Cancer. 2006 Nov 1;107(9):2108-21

Epithelioid haemangioendothelioma - Discussion Points