Malignant neoplasm of perivascular epithelioid cells of the liver
Departments of Pathology, London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada. Archives of pathology & laboratory medicine
(Impact Factor: 2.84).
09/2006; 130(8):1219-22. DOI: 10.1043/1543-2165(2006)130[1219:MNOPEC]2.0.CO;2
Neoplasms of perivascular epithelioid cells (PEComas) have in common the coexpression of muscle and melanocytic immunohistochemical markers. Although this group includes entities with distinct clinical features, such as angiomyolipoma, clear cell sugar tumor of the lung, and lymphangioleiomyomatosis, similar tumors have been documented in an increasing diversity of locations. The term PEComa is now generally used in reference to these lesions that are not angiomyolipomas, clear cell sugar tumors, or lymphangioleiomyomatoses. While most reported PEComas have behaved in a benign fashion, malignant PEComas have occasionally been documented. We present a case of hepatic PEComa with benign histologic features, which nonetheless presented with metastases to multiple sites nearly 9 years later. This case represents the second documented malignant PEComa of the liver, as well as the longest follow-up of a surviving patient with a malignant PEComa, emphasizing both the need for criteria that more accurately predict the behavior of PEComas and the necessity of long-term follow-up of patients with PEComas.
Available from: PubMed Central
- "Hepatic PEComa occurs most commonly in females (7), and symptoms of hepatic PEComa usually show no specificity. In the present study, 11 out of 20 patients with hepatic PEComa had mild to significant non-specific complaints. "
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ABSTRACT: Perivascular epithelioid cell tumor (PEComa) is a rare tumor that originates from mesenchymal tissues. Cases of PEComa in the liver are extremely rare. The present study aimed to analyze the clinical features of PEComa in the liver and discuss its management. Here we report a 25-year-old female with multiple lesions of low density with poorly defined borders in the liver, as shown by a computed tomography (CT) scan. A partial hepatectomy was proceeded and PEComa was diagnosed by immunohistochemistry. No evidence of recurrence was observed during the one year follow-up. A total of 20 patients with hepatic PEComa, including one case from the present study and 19 cases that were reported in literature between June 2001 and December 2012, were reviewed and analyzed. The mean patient age was 43.4 years (range, 25-67 years) and the cases consisted of 18 female and two male patients. The tumor size ranged between 2.0×1.6 and 15.0×12.0 cm. Of the 20 patients, nine were asymptomatic and 11 had mild to significant complaints. Immunohistochemistry plays a key role in the diagnosis of PEComa. All the cases in this study were strongly positive for human melanoma black-45. A surgical resection is the gold standard for curative intent. All the patients underwent a surgical resection and none were administered perioperative chemotherapy or radiotherapy. In total, 13 of the 14 patients with follow-up information survived during the 8-36-month follow-up period and one patient succumbed due to recurrence two years after the surgery.
Available from: Federico Selvaggi
- "PEComa of the liver is extremely unusual and only a few cases have been reported to date. To the best of our knowledge, there are less than 10 reported cases of liver PEComas . The right lobe of the liver is the most common site and all cases occurred adjacent to the ligamentum teres and falciform ligament . "
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ABSTRACT: Malignant perivascular epitheliod cell tumor (PEComa) is a very rare entity composed of distinctive perivascular epitheliod cells with variable immunoreactivity for melanocytic and muscle markers. At present this neoplasm does not have a known normal cellular counterpart and the natural history is often unpredictable. Up to now, few cases of PEComa have been described and treatment modalities are still controversial, particularly in advanced conditions.
We handled the case of a 42-year-old man with unresectable PEComa of the abdomen. A 7 cm hepatic hypodense lesion between segment V and VIII of the liver and diffuse intraperitoneal nodules of 0,3-3,5 cm along the right subcapsular hepatic region, were documented by a CT scan. Radiological images showed abnormal lymph nodes of the right internal mammary chain and anterior mediastinum. The patient underwent an explorative laparotomy for uncontrolled intraabdominal hemorrhage without a well-defined preoperative tumor diagnosis. At surgery, multiple lobulated nodules containing hemorrhagic fluid on the liver surface, peritoneum and omentum were confirmed. The procedure had a palliative intent and consisted of hemostasis, hematomas evacuation and omentectomy. The diagnosis of PEComa was made after surgery on the basis of morphological and immunohistochemical criteria. Radiological and intra operative findings suggest that the mass has an hepatic origin with diffuse involvement of hepatic capsule and suspensory ligaments. The patient received medical support care with blood and plasma transfusions. In our experience, PEComa was clinically malignant, leading to a fatal outcome 25 days after hospital admission of patient.
Here we report and discuss the peculiar clinical, radiological and morphological presentation of unresectable PEComa. Although in the majority of the reported series, PEComas show a more better prognosis, our case presents with a particular aggressive biological behaviour. The importance of a correct preoperative diagnosis, the need for more effective targeted therapies based on tumor molecular knowledge and evidence-based clinical studies are emphasized together with a revision of the concerning scientific literature.
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ABSTRACT: Hepatic angiomyolipoma (AML) is known as a rare benign tumor with invasive growth. In the past, some of these tumors were
misdiagnosed as hepatocellular carcinomas, because of the similar pattern on imaging studies. Recently, correct diagnoses
have been increasing, with the development of HMB-45 immunohistochemical staining, and it appears that the majority of these
tumors behave as benign tumors. However, there are not a few cases which have resulted in fatal courses because of recurrence
and metastasis of the tumor. The clinical features and signs of the malignant potential of this tumor are unknown; thus, the
management and treatment of the tumor are still controversial. Here in this article, we report a case of hepatic AML which
showed a size increase of 175% in 1year, and portal vein thrombosis detected by angiography. During a follow up of 3years
after a curative hepatic lobectomy, no metastasis or recurrence was seen. Review of the literature suggests that portal vein
thrombosis could be one of the markers of the malignant potential and transformation of this tumor. Therefore, in this paper,
we recommend surgical treatment of hepatic AML in which there is a strong suspicion of portal vein thrombosis.
KeywordsHepatic angiomyolipoma-Portal vein thrombosis-HMB-45-Malignant-PEComa
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