title: A case of a resectable single hepatic epithelioid hemangioendothelioma with characteristic imaging by ADC map.
abstract: A 47-year-old woman with a single-nodule hepatic tumor was referred to our hospital. She had no symptoms. The tumor was located at the surface of the right lobe of the liver; it showed peripheral low signal intensity on a magnetic resonance imaging apparent diffusion coefficient (ADC) map, and an influx of blood flow into the peripheral area of the tumor at the early vascular phase on perflubutane microbubble (Sonazoid(®)) contrast-enhanced (CE) ultrasonography. Since we suspected a malignant tumor, the patient underwent surgical resection. The hepatic tumor was resected curatively. Pathological examination revealed that the tumor was composed of epithelioid cells with an epithelioid structure and/or cord-like structure. Immunohistochemical staining was positive for cluster of differentiation 34 and factor VIII-related antigen. Based on the above, a final diagnosis of hepatic epithelioid hemangioendothelioma (EHE) was made. Hepatic EHE is a rare hepatic tumor: only a few cases of hepatic EHE with curative resection have been reported. We were unable to reach a diagnosis of hepatic EHE by imaging studies; however, an ADC map was useful in showing the malignant potential of the tumor, and CE ultrasonography was useful in revealing the peripheral blood flow of the tumor. When an unusual hepatic mass is encountered, hepatic EHE should be kept in mind, and the mass should be inspected with more than one imaging modality, including an ADC map, in the process of differential diagnosis.
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan. oohh1969@yahoo.co.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okano
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Tomomasa
authors.initials: T
authors.lastname: Tochio
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suga
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kumazawa
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Isono
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Matsusaki
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sase
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Mukai
authors.affiliation: Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Nishimura
authors.affiliation: Department of Radiology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Matsushima
authors.affiliation: Department of Pathology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Youichirou
authors.initials: Y
authors.lastname: Baba
authors.affiliation: Department of Pathology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Murata
authors.affiliation: Department of Surgery, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hamada
authors.affiliation: Department of Surgery, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Taoka
mesh_terms: D018952:Antigens, CD34 / Q000032:analysis; D003287:Contrast Media; D005260:Female; D018323:Hemangioendothelioma, Epithelioid / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014463:Ultrasonography; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D018952:Antigens, CD34; D003287:Contrast Media; D014841:von Willebrand Factor
keywords: ADC map; Epithelioid hemangioendothelioma; Liver tumor