Malignant hemangiopericytoma of the liver: report of a case

A 30 year old female was admitted with right upper abdominal pain and fever. Ultrasonography and computed tomography revealed a large cystic mass in the right lobe of the liver, and aspiration bacteriology was negative. A right hepatic lobectomy was performed for a suspected cystadenocarcinoma, however, the tumor was histologically diagnosed as a hemangiopericytoma with prominent venous invasion. The patient died within a short time of multiple pulmonary metastases. Primary hepatic hemangiopericytoma is extremely rare, and according to our research, this is only the 4th case reported in the literature.     

Recurrent hemangiopericytoma of the liver: Report of a case

We present herein the case of a 63-year-old man with a locally recurrent hemangiopericytoma in the hepatic hilum. The patient presented to our hospital for the investigation of elevated transaminases 6 years after undergoing resection of a hemangiopericytoma followed by chemotherapy at another hospital. Various imaging techniques demonstrated a well-circumscribed, hypervascular tumor with central necrosis in the hepatic hilum. Establishing a preoperative diagnosis would have been difficult without the information that he had previously had a hemangiopericytoma of the abdominal cavity. An extended right hepatic lobectomy was performed and histopathological examination confirmed the diagnosis of recurrent hemangiopericytoma. Although hemangiopericytoma is a rare tumor, the clinical presentation and radiologic features of this case were fairly typical.     

Meningeal hemangiopericytoma manifesting as massive intracranial hemorrhage--two case reports

Meningeal hemangiopericytoma is rare, and only seven cases have manifested as intracranial hemorrhage. We treated two patients with meningeal hemangiopericytoma manifesting as life-threatening massive intracerebral hemorrhage. Case 1: A 66-year-old woman presented with consciousness disturbance and left hemiparesis. Computed tomography showed a mass lesion in the right frontal parasagittal region and massive hematoma in the brain tissue at the medial border of the lesion. Immediate evacuation of the hematoma was performed. Postoperative magnetic resonance imaging revealed a well-enhanced mass lesion with small intratumoral hemorrhage. The tumor was removed totally through a bilateral frontal craniotomy. The postoperative course was uneventful. The histological diagnosis was meningeal hemangiopericytoma. Radiotherapy was not performed. Case 2: A 59-year-old man presented with consciousness disturbance. Computed tomography showed a mass lesion in the right frontotemporal convexity region and massive hematoma in the brain tissue at the medial border of the lesion. His neurological condition was refractory to any treatment and the clinical diagnosis of brain death was confirmed. Autopsy was performed and the histological diagnosis was meningeal hemangiopericytoma. Meningeal hemangiopericytoma manifesting as intracranial hemorrhage is quite rare, but carries the risk of life-threatening massive bleeding from the tumor.     

Hemangiopericytoma in the trigone of the lateral ventricle

A 67-year-old right-handed woman presented with a case of hemangiopericytoma in the lateral ventricle manifesting as digit number memory disturbance, sensory aphasia, and right quadrantanopsia. Magnetic resonance imaging demonstrated a 6-cm homogeneously enhanced mass in the trigone of the left lateral ventricle. The tumor was totally removed via the left inferior temporal gyrus. The histological findings were consistent with hemangiopericytoma. Differential diagnosis of hemangiopericytoma from meningioma and solitary fibrous tumors is very important because the clinical behavior of hemangiopericytoma is very aggressive, including local recurrence or distant metastases in the central nervous system and periphery. Histological confirmation is required to make a definitive diagnosis. The present patient did not receive radiation therapy, but developed no local recurrence or metastases. Complete surgical resection and awareness of hemangiopericytoma in the lateral ventricle are very important for good clinical outcome.     

A case of hemangiopericytoma in the retroperitoneal cavity and a review of literature in Japan

A case of hemangiopericytoma in the pelvic retroperitoneum is reported. The patient, a 45-year-old man, visited us with a complaint of sudden urinary retention. Intravenous pyelogram and computerized tomographic scan revealed a large pelvic mass displacing the bladder to the left superiorly. Laparotomy was performed, and biopsy showed the mass to be a malignant hemangiopericytoma. He underwent a surgical excision after receiving irradiation to the true pelvis and embolization of right internal iliac. He developed multiple pulmonary and liver metastases and died 2 years after surgery. Thirty cases of retroperitoneal hemangiopericytoma reported in Japan are reviewed.     

Hemangiopericytoma of renal pelvis--an unusual tumor in an adolescent

Since the initial report of renal hemangiopericytoma in 1955, only 39 cases of this rare vascular neoplasm, involving the renal capsule, parenchyma, or sinus have been described in the world literature. Herein we describe a case of a 15-year-old adolescent boy with this tumor arising from right renal pelvis. A radical right nephrectomy was performed. Histologic and immunologic studies revealed a hemangiopericytoma of renal pelvis soft tissues. The patient did well postoperatively and remains disease-free at the present time.     

Pneumothorax due to hemangiopericytoma metastasis from the thigh

A 25-year-old female had malignant hemangiopericytoma of the right thigh resected. Three years later, right pneumothorax developed, necessitating a thoracotomy. A 3-cm bulla was discovered on the lower right pulmonary lobe and was subsequently resected. Microscopy showed tumor cells which were positive for actin, but negative for epithelial membrane antigen, vimentin, and factor VIII-related antigen—features compatible with those of the thigh. The patient has been free of the disease for five years. Pertinent literature reveals similar cases with hemangioendothelioma but offers few reports on pneumothorax caused by metastatic hemangiopericytoma.     

Hemangiopericytoma in the trigone of the lateral ventricle--case report

A 40-year-old male presented with hemangiopericytoma in the lateral ventricle manifesting as headaches persisting for 6 months associated with vomiting and visual obscurations for one month. Computed tomography and magnetic resonance imaging of the brain showed a large tumor in the trigone of the right lateral ventricle. The highly vascular tumor was completely excised. The histological diagnosis was hemangiopericytoma. Hemangiopericytoma is rarely located in the lateral ventricle and is difficult to differentiate from meningioma by neuroimaging methods.     

Intraventricular hemangiopericytoma--case report.

A very rare large intraventricular hemangiopericytoma occurred in a 41-year-old male with a 2-month history of headache and paresthesia of the right shoulder and arm. The tumor was partially removed, followed by 50 Gy local Linac irradiation given over 6 weeks. Four months later the residual tumor demonstrated a marked decrease in size and vascularity. The residual tumor was totally removed with less operative bleeding than at the initial operation. This is the first reported case of hemangiopericytoma located in the trigone of the lateral ventricle.     

Tumor embolism in the right atrium after hepatic artery ligation for hepatoma

A case of tumor embolism in the right atrium after hepatic artery ligation for hepatoma was reported. Patient was a 55 year old male complaining of upper abdominal pain. Preoperative angiogram and scintigram revealed multinodular hepatomas in the right and middle lobes of the liver. During the first week after the ligation of the right and middle hepatic arteries, the patient progressed satisfactorily. But his condition gradually deteriorated thereafter and sudden hypotension occurred on the 22nd postoperative day with a fatal sequela. At autopsy, the orifice of the right atrium was impacted by a tumor embolus. The cause of death seemed to be attributable to this embolus liberated from the hepatic veins. Accordingly, we emphasize the necessity of careful angiographic evaluation not only of the hepatic inflow but of the outflow tract in performing hepatic artery ligation as a treatment of nonresectable hepatoma.     

Primary hemangiopericytoma of the chest wall--a case report]

An extremely rare case of a primary hemangiopericytoma of the chest wall was reported. A 40-year-old female without any complaints was detected to have an abnormal shadow in the right chest wall on a chest X-ray film. The tumor was 2.6 x 2.2 x 2.0 cm in size and was resected together with the 8th rib which adhered to the tumor. Postoperative pathohistological examination led to the diagnosis of hemangiopericytoma. Postoperative course was uneventful, and the patient is now doing well and has had no recurrence for 11 months since the operation. A brief review was made on 9 cases collected from the literature.     

Resection of primary pulmonary hemangiopericytoma: A report of two cases

We report herein the cases of two patients who underwent resection of a primary pulmonary hemangiopericytoma. The first patient was a 58-year-old man found to have a mass-like shadow of about 5 cm in diameter in the right hilum by a routine chest X-ray. Subsequent magnetic resonance imaging (MRI) showed a probable mediastinal tumor, and surgery was performed. Postoperative pathological examinations comfirmed the diagnosis of pulmonary hemangiopericytoma. The second patient was a 21-year-old woman found to have a mass-like shadow of about 2 cm in diameter in the left middle lung field. As a preoperative diagnosis could not be made, exploratory surgery was performed and the left S₆ segment was excised. A definitive diagnosis of pulmonary hemangiopericytoma was established postoperatively by pathological examination. Primary pulmonary hemangiopericytoma is an extremely rare type of tumor, with only 36 cases having been reported in the Japanese literature to date, including out 2 cases. A discussion following the case reports examines the sex, age, initial manifestations, sites, and methods of surgery employed in these 36 cases.The abstract of this paper was presented at the 61st Meeting of the Kansai Chapter of the Japan Lung Cancer Association.     

Excision of a large pineal region hemangiopericytoma (angioblastic meningioma,hemangiopericytoma type)

A large hemangiopericytoma was located posterocentrally. The patient presented with headaches and papilledema. Surgical management consisted of total gross excision by a combined right occipital transtentorial and right occipitoparietal transfalcine approach under magnification in three stages over a 6-week period. Removal was aided by dilatation of the right temperooccipital horn (“trapped ventricle”) and meningioma-like encapsulation allowed separation of the tumor from the brain and surrounding structures after internal debulking of the tumor. Subsequent peritoneal shunting of the trapped ventricular horn and 5000 rads of radiotherapy were given to the patient. She remains well with an inferior quadrantanopsia on the left side more than 1 year after treatment. Meningiomas of the pineal region, the relationship of meningioma to hemangiopericytoma and malignant mesenchymal tumors (sarcomas) are considered in reference to presumed cells of origin.     

Hemangiopericytomatous meningioma metastasized to the liver: Report of a case and review of the literature

A 54-year-old male was admitted to our hospital for treatment of a liver tumor which was pointed out by screening ultrasonography. Computed tomography revealed a tumor in the right lobe of the liver measuring 7 cm in diameter. Angiography revealed a hypervascular tumor. A hepatocellular carcinoma or hypervascular metastatic tumor was suspected. A right hepatic lobectomy was performed. The patient had previously undergone operations for a hemangiopericytomatous meningioma in the occipital fossa in 1972 and 1977. The histological findings of the liver tumor were identical to those for hemangiopericytomatous meningioma, so the etiology was considered to be liver metastasis from the previous meningioma. Nineteen cases of extracranial metastasis of hemangiopericytomatous meningioma have been reported in the literature, but hepatic resections of this metastasizing tumor have been very rare.     

Successful resection of cholangiocellular carcinoma with tumor thrombus in the main trunk of the portal vein

A space-occupying lesion in the right hepatic lobe, with dilated peripheral bile ducts, was observed by ultrasonography and computed tomography in a 50-year-old man with right upper quadrant abdominal pain. One month later, this lesion evidenced rapid growth and a tumor thrombus, which completely occluded the main trunk and the left primary branch of the portal vein, had developed. The tumor was diagnosed as a cholangiocellular carcinoma with an unusual pattern of intravascular extension. The primary tumor and the portal tumor thrombus were resected via a right hepatic trisegmentectomy combined with resection of the portal vein and extrahepatic bile duct, using a superior mesenteric vein—left femoral vein catheter bypass (SMV—FV bypass). The SMV—FV bypass was found to effectively reduce intraoperative hemorrhage.     

射频消融肝脏恶性肿瘤并发症的防治

目的探讨肝恶性肿瘤射频消融术中、术后并发症的预防和治疗. 方法 1999年10月～2003年3月,353例经病理和临床证实为原发性肝癌、继发性肝恶性肿瘤者进行452例次射频消融治疗,其中经皮肝穿刺治疗344例,开腹术中进行9例.未手术原发性肝癌198例,肝癌术后复发81例,继发性肝恶性肿瘤74例.定期随访,了解与手术相关的近、远期并发症. 结果发生并发症12例,其中电极皮肤灼伤2例,气胸1例,右胸腔积液1例,腔静脉血栓1例,右肝管损伤狭窄1例,胃损伤外瘘1例,肝左外叶胆管外瘘1例,单纯肝脓肿1例,肝脓肿致升结肠外瘘1例,肝脓肿致十二指肠、肝、右胸腔内瘘1例,内出血1例.并发症发生率2.65%(12/452),并发症相关死亡率8.33%(1/12). 结论射频消融是一种微创治疗,但对于肝门区、肝表面和与空腔脏器贴近的部位,尤其是有腹腔手术史且空腔脏器与肝脏相粘连者,经皮肝穿刺射频治疗有一定危险性.术前适应证选择恰当,术中仔细操作,术后加强监护、预防感染、止血等,一些并发症是可以有效预防和治疗的.     

A case report of primary hemangiopericytoma of the chest wall

A 35-year-male was found to have an abnormal shadow with an extrapleural sign located in the right lower lung field by a chest X-ray. Chest CT revealed a well demarcated tumor in the chest wall adjacent to the 4th rib. Chest MRI showed that the tumor contained punctate or linear low-intensity areas, which were considered to be small blood vessels. A diagnosis of hemangiopericytoma was established by percutaneous needle biopsy. Under the definite diagnosis, extended resection of the chest wall was performed to remove the tumor with a surgical margin of more than 5 cm, corresponding to surgery for other malignant soft-tissue neoplasmas. Hemangiopericytomas rarely arise in the chest wall, although they can be found in any region which contains pericytes. Preoperative definite diagnoses of hemangiopericytoma have rarely been reported. However, preoperative diagnosis is an important factor in deciding the operative procedure for hemangiopericytoma. It has been reported that hemangiopericytomas show local recurrences and distant metastases, although they are histologically benign. We consider that hemangiopericytomas in the chest wall should be treated with extensive resection corresponding to surgery for other malignant soft-tissue neoplasmas.     

Hepatic artery ligation for metastastic leiomyosarcoma of the liver

A case is presented of metastatic leiomyosarcoma of the liver in which the right and left hepatic arteries were ligated in two stages. Although a moderate disturbance in liver functions was found postoperatively, the patient tolerated them well. The postoperative roentogenological examinations showed an apparent regression of the tumor indicating that hepatic artery ligation can be useful as a palliative therapy for diffuse metastatic liver tumors.     

A suitable animal model for laparoscopic hepatic resection training

Background There is a growing interest in using laparoscopy for hepatic resection. However, structured training is lacking in part because of the lack of an ideal animal training model. We sought to identify an animal model whose liver anatomy significantly resembled that of the human liver and to assess the feasibility of learning laparoscopic hepatic inflow and outflow dissection and parenchyma transection on this model. Methods The inflow and outflow structures of the sheep liver were demonstrated via surgical dissection and contrast studies. Laparoscopic left major hepatic resections were performed. Results The portal hepatis of all 12 sheep (8 for anatomic study and 4 for laparoscopic hepatic resection) resembled that of human livers. The portal vein (PV) was located posteriorly; the common hepatic artery (CHA) and the common bile duct (CBD) were located anterior medially and anterior laterally with respect to the portal hepatis. The main PV bifurcated into a short right and a long left PV. The extrahepatic right PV then bifurcated into right posterior and anterior sectoral PV. The CBD and CHA bifurcated into left and right systems. The cystic duct originated from the right hepatic duct. The cystic artery originated from the right HA in 11/12 animals. The left hepatic vein drained directly into the inferior vena cava (IVC). The middle and the right hepatic veins formed a short common channel before entering the IVC. Multiple venous tributaries drained directly into IVC. Familiarity with sheep liver anatomy allowed laparoscopic left hepatic lobe (left medial and lateral segments) resection to be performed with accuracy and preservation of the middle hepatic vein. Conclusions The surgical anatomy of sheep liver resembled that of human liver. Laparoscopic major hepatic resection can be performed with accuracy using this information. Sheep is therefore an ideal animal model for advanced surgical training in laparoscopic hepatic resection.     

巨大右侧肾上腺血管瘤的手术切除

目的 总结巨大右侧肾上腺血管瘤的诊断及治疗。方法 回顾性分析我院1例巨大右侧肾上腺血管瘤的特点及治疗，结合献讨论该疾病的诊断、治疗。结果 本病呈良性经过，临床症状以压迫周围器官为主，少数病例可合并高血压等表现，切除可治愈。结论 本病罕见，须与右肝肿瘤鉴别，切除治疗预后良好。