Uncommon hepatic tumors: iconographic essay – Part 2

In cases where typical aspects are shown, the diagnosis of most frequent hepatic lesions can be made with some safety by means of several imaging methods; on the other hand, uncommon lesions generally represent a diagnostic challenge for the radiologist. In the present second part of the study, the authors describe four rare hepatic lesions, as follows: primary hepatic lymphoma, myofibroblastic tumor, primary hepatic neuroendocrine tumor and desmoplastic small round cell tumor, approaching their main characteristics and imaging findings with emphasis on computed tomography and magnetic resonance imaging.

Neoplasms; Liver; Atypical; Computed tomography; Magnetic resonance imaging

Authorship

Bruno Cheregati Pedrassa

MDs, Radiologists, Fellows at Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilMDs, Radiologists, Fellows at Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Eduardo Lima da Rocha

Marcelo Longo Kierzenbaum

Renata Lilian Bormann

Viviane Vieira Francisc

PhD, MD, Radiologist, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilPhD, MD, Radiologist, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Giuseppe D’Ippolito Mailing Address: Dr. Giuseppe D’Ippolito. Departamento de Diagnóstico por Imagem – EPM-Unifesp. Rua Napoleão de Barros, 800, Vila Clementino. São Paulo, SP, Brazil, 04024-012. E-mail: giuseppe_dr@uol.com.br.

Associate Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilAssociate Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Mailing Address: Dr. Giuseppe D’Ippolito. Departamento de Diagnóstico por Imagem – EPM-Unifesp. Rua Napoleão de Barros, 800, Vila Clementino. São Paulo, SP, Brazil, 04024-012. E-mail: giuseppe_dr@uol.com.br.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (7)

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Figure 1
Primary hepatic lymphoma. A: Ultrasonography demonstrating heterogeneous liver mass located in the confluence between the right and left lobes with target sign. B: Correlation with CT highlights peripheral, lamellar enhancement after intravenous contrast agent injection.

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Figure 2
MRI of a patient with primary hepatic lymphoma. Heterogeneous mass in the right liver lobe, with target sign and hyposignal on T1-weighted (A) and moderate to hypersignal on T2-weighted sequences (B).

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Figure 3
Inflammatory pseudotumor. A 66-year-old man with pain in the right hypochondrium associated with fever and leukocytosis. Non-contrast enhanced CT (A) and after intravenous contrast injection (B,C) demonstrates the presence of a hypodense and hypovascularized lesion in the segments II and IV, with permeative appearance, simulating infiltrating lesion. Follow-up CT three-month after antibiotic therapy demonstrates complete lesion regression (D).

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Figure 4
Primary hepatic neuroendocrine carcinoma. Computed tomography, non-contrast enhanced image (A) and after intravenous contrast media injection (B,C,D) demonstrate the presence of a heterogeneous, quite vascularized mass with some foci of calcification and intermingled cystic areas, occupying the left liver lobe.

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Figure 5
Primary hepatic neuroendocrine carcinoma (same patient on Figure 4). MRI, T1--weighted (A), T2-weighted (B) and contrast-enhanced (C) sequences demonstrate heterogeneous mass with hyposignal on T1-weighted and hypersignal on T2-weighted images intermingled with multiple cystic areas (some of them with fluid-fluid level). The lesion presented restriction to water diffusion at the diffusion sequence (D).

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Figure 6
Primary hepatic neuroendocrine carcinoma (same patient on Figures 4 and 5). MRI, coronal T2-weighted image (A) demonstrates heterogeneous mass occupying almost the whole left liver lobe, with hypersignal intermingled with multiple cystic areas, with excellent correspondence with the macroscopic aspect observed on the surgical specimen (B).

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Figure 7
Desmoplastic small round cell tumor. CT, portal phase (A,B) demonstrates hypodense, hypovascularized, expansile mass infiltrating the hepatic hilum in association with subtle segmental dilatation of left intrahepatic biliary tract. Also, an intraparenchymal component is observed. T1- and T2-weighted MRI images with fat suppression (D) demonstrates hyposignal from the lesion on T1- weighted and hypersignal on T2- weighted sequences extending toward the hepatic hilum.

Figure 1 Primary hepatic lymphoma. A: Ultrasonography demonstrating heterogeneous liver mass located in the confluence between the right and left lobes with target sign. B: Correlation with CT highlights peripheral, lamellar enhancement after intravenous contrast agent injection.

Figure 2 MRI of a patient with primary hepatic lymphoma. Heterogeneous mass in the right liver lobe, with target sign and hyposignal on T1-weighted (A) and moderate to hypersignal on T2-weighted sequences (B).

Figure 3 Inflammatory pseudotumor. A 66-year-old man with pain in the right hypochondrium associated with fever and leukocytosis. Non-contrast enhanced CT (A) and after intravenous contrast injection (B,C) demonstrates the presence of a hypodense and hypovascularized lesion in the segments II and IV, with permeative appearance, simulating infiltrating lesion. Follow-up CT three-month after antibiotic therapy demonstrates complete lesion regression (D).

Figure 4 Primary hepatic neuroendocrine carcinoma. Computed tomography, non-contrast enhanced image (A) and after intravenous contrast media injection (B,C,D) demonstrate the presence of a heterogeneous, quite vascularized mass with some foci of calcification and intermingled cystic areas, occupying the left liver lobe.

Figure 5 Primary hepatic neuroendocrine carcinoma (same patient on Figure 4). MRI, T1--weighted (A), T2-weighted (B) and contrast-enhanced (C) sequences demonstrate heterogeneous mass with hyposignal on T1-weighted and hypersignal on T2-weighted images intermingled with multiple cystic areas (some of them with fluid-fluid level). The lesion presented restriction to water diffusion at the diffusion sequence (D).

Figure 6 Primary hepatic neuroendocrine carcinoma (same patient on Figures 4 and 5). MRI, coronal T2-weighted image (A) demonstrates heterogeneous mass occupying almost the whole left liver lobe, with hypersignal intermingled with multiple cystic areas, with excellent correspondence with the macroscopic aspect observed on the surgical specimen (B).

Figure 7 Desmoplastic small round cell tumor. CT, portal phase (A,B) demonstrates hypodense, hypovascularized, expansile mass infiltrating the hepatic hilum in association with subtle segmental dilatation of left intrahepatic biliary tract. Also, an intraparenchymal component is observed. T1- and T2-weighted MRI images with fat suppression (D) demonstrates hyposignal from the lesion on T1- weighted and hypersignal on T2- weighted sequences extending toward the hepatic hilum.

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E-mail: radiologiabrasileira@cbr.org.br

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