Discussion on MDT of recurrent retreatment after surgery for hepatic epithelioid angioendothelioma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Yimin , LIU Fusheng , ZHANG Zhonglin ,  YUAN Yufeng

Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, P. R. China;

Corresponding author：

YUAN Yufeng, Email: yuanyf1971@whu.edu.cn

Keywords：

hepatic epithelioid angioendothelioma; postoperative recurrence; multidisciplinary assistance team; reoperation resection

DOI：

10.7507/1007-9424.202307026

Video：

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Objective To discuss the treatment of a patient with postoperative recurrence of hepatic epithelioid hemangioendothelioma by multidisciplinary team (MDT) model. Methods The MDT discussion and disease diagnosis and treatment process of one patient with recurrent hepatic epithelioid angioendothelioma admitted to Zhongnan Hospital of Wuhan University in April 2021 were summarized. Results The patient was admitted to the hospital for “more than one year after operation of hepatic epithelioid hemangioendothelioma”. Two years ago, the patient’s upper abdominal CT examination showed that there was a kind of round and slightly low-density nodule shadow in the left lateral lobe of the liver, which was about 30 mm×22 mm in size, and the boundary around the nodule was clear. There was a punctate high-density shadow in the S7 segment of the liver, which was not given special treatment and was reviewed regularly. One year later, the enhanced CT examination of the liver showed that the mass in the left lateral lobe of the liver was larger than before, and multiple nodules were seen in the right lobe of the liver. After admission, MRI examination showed multiple abnormal signal foci in the liver, so atypical hemangioma-like lesions (epithelioid hemangioendothelioma may be considered) were considered. Laparoscopic left lateral lobe resection + right liver lesion resection + radiofrequency ablation of liver lesion were performed in our department, and the patient recovered well after surgery. Four months after operation, MRI reexamined and found that intrahepatic metastasis might recur, so he was re-hospitalized, and after MDT discussion, it was decided to perform laparoscopic radiofrequency ablation of liver lesions (fluorescent laparoscopy) and laparoscopic partial liver resection (fluorescent laparoscopy) again. The patient recovered well after operation, and there was no recurrence after follow-up. Conclusion For patients with postoperative recurrence of hepatic epithelioid hemangioendothelioma, a comprehensive reoperation plan is made through MDT discussion, which may bring the best prognosis to patients.

Citation： ZHU Yimin, LIU Fusheng, ZHANG Zhonglin, YUAN Yufeng. Discussion on MDT of recurrent retreatment after surgery for hepatic epithelioid angioendothelioma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(9): 1047-1053. doi: 10.7507/1007-9424.202307026 Copy

1.	Weiss SW, Enzinger FM. Epithelioid hemangioendothelioma: A vascular tumor often mistaken for a carcinoma. Cancer, 1982, 50(5): 970-981.
2.	Ishak KG, Sesterhenn IA, Goodman ZD, et al. Epithelioid hemangioendothelioma of the liver: a clinicopathologic and follow-up study of 32 cases. Hum Pathol, 1984, 15(9): 839-852.
3.	Choi KH, Moon WS. Epithelioid hemangioendothelioma of the liver. Clin Mol Hepatol, 2013, 19(3): 315-319.
4.	Läuffer JM, Zimmermann A, Krähenbühl L, et al. Epithelioid hemangioendothelioma of the liver. A rare hepatic tumor. Cancer, 1996, 78(11): 2318-2327.
5.	Mehrabi A, Kashfi A, Fonouni H, et al. Primary malignant hepatic epithelioid hemangioendothelioma: a comprehensive review of the literature with emphasis on the surgical therapy. Cancer, 2006, 107(9): 2108-2121.
6.	Sanduzzi-Zamparelli M, Rimola J, Montironi C, et al. Hepatic epithelioid hemangioendothelioma: An international multicenter study. Dig Liver Dis, 2020, 52(9): 1041-1046.
7.	Mehrabi A, Kashfi A, Schemmer P, et al. Surgical treatment of primary hepatic epithelioid hemangioendothelioma. Transplantation, 2005, 80(1 Suppl): S109-112.
8.	Makhlouf HR, Ishak KG, Goodman ZD. Epithelioid hemangioendothelioma of the liver: a clinicopathologic study of 137 cases. Cancer, 1999, 85(3): 562-582.
9.	Treska V, Daum O, Svajdler M, et al. Hepatic epithelioid hemangioendothelioma—a rare tumor and diagnostic dilemma. In Vivo, 2017, 31(4): 763-767.
10.	Tanas MR, Sboner A, Oliveira AM, et al. Identification of a disease-defining gene fusion in epithelioid hemangioendothelioma. Sci Transl Med, 2011, 3(98): 98ra82.
11.	Hu HJ, Jin YW, Jing QY, et al. Hepatic epithelioid heman-gioendothelioma: Dilemma and challenges in the preoperative diagnosis. World J Gastroenterol, 2016, 22(41): 9247-9250.
12.	刘露, 鲁亚, 刘曦娇, 等. 肝上皮样血管内皮细胞瘤的影像学表现. 中国普外基础与临床杂志, 2018, 25(2): 229-234.
13.	Dong Y, Wang WP, Cantisani V, et al. Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma. World J Gastroenterol, 2016, 22(19): 4741-4749.
14.	Ganeshan D, Pickhardt PJ, Morani AC, et al. Hepatic hemangioendothelioma: CT, MR, and FDG-PET-CT in 67 patients-a bi-institutional comprehensive cancer center review. Eur Radiol, 2020, 30(5): 2435-2442.
15.	Dong A, Dong H, Wang Y, et al. MRI and FDG PET/CT findings of hepatic epithelioid hemangioendothelioma. Clin Nucl Med, 2013, 38(2): e66-e73.
16.	Jang JK, Thomas R, Braschi-Amirfarzan M, et al. A Review of the spectrum of imaging manifestations of epithelioid heman-gioendothelioma. AJR Am J Roentgenol, 2020, 215(5): 1290-1298.
17.	Wang W, Liu G, Hu P, et al. Imaging characteristics and prognostic values of hepatic epithelioid hemangioendothelioma on 18F-FDG PET/CT. Clin Exp Med, 2020, 20(4): 557-567.
18.	Jeong HT, Kim MJ, Chung YE, et al. Gadoxetate disodium-enhanced MRI of mass-forming intrahepatic cholangiocarcinomas: imaging-histologic correlation. AJR Am J Roentgenol, 2013, 201(4): W603-W611.
19.	Studer LL, Selby DM. Hepatic epithelioid hemangioendothelioma. Arch Pathol Lab Med, 2018, 142(2): 263-267.
20.	Pichlmayr R, Weimann A, Ringe B. Indications for liver transplantation in hepatobiliary malignancy. Hepatology, 1994, 20(1 Pt 2): 33S-40S. doi: 10.1016/0270-9139(94)90271-2.
21.	Remiszewski P, Szczerba E, Kalinowski P, et al. Epithelioid hemangioendothelioma of the liver as a rare indication for liver transplantation. World J Gastroenterol, 2014, 20(32): 11333-11339.
22.	Marino IR, Todo S, Tzakis AG, et al. Treatment of hepatic epithelioid hemangioendothelioma with liver transplantation. Cancer, 1988, 62(10): 2079-2084.
23.	Lerut JP, Orlando G, Adam R, et al. The place of liver transplantation in the treatment of hepatic epitheloid hemangioendothelioma: report of the European liver transplant registry. Ann Surg, 2007, 246(6): 949-957.
24.	Otrock ZK, Al-Kutoubi A, Kattar MM, et al. Spontaneous complete regression of hepatic epithelioid haemangioendothelioma. Lancet Oncol, 2006, 7(5): 439-441.
25.	Komatsu S, Iwasaki T, Demizu Y, et al. Two-stage treatment with hepatectomy and carbon-ion radiotherapy for multiple hepatic epithelioid hemangioendotheliomas. World J Gastroenterol, 2014, 20(26): 8729-8735.
26.	Yousaf N, Maruzzo M, Judson I, et al. Systemic treatment options for epithelioid haemangioendothelioma: the Royal Marsden Hospital experience. Anticancer Res 35(1): 473-480.
27.	Grotz TE, Nagorney D, Donohue J, et al. Hepatic epithelioid haemangioendothelioma: is transplantation the only treatment option? HPB (Oxford), 2010, 12(8): 546-553.

1. Weiss SW, Enzinger FM. Epithelioid hemangioendothelioma: A vascular tumor often mistaken for a carcinoma. Cancer, 1982, 50(5): 970-981.
2. Ishak KG, Sesterhenn IA, Goodman ZD, et al. Epithelioid hemangioendothelioma of the liver: a clinicopathologic and follow-up study of 32 cases. Hum Pathol, 1984, 15(9): 839-852.
3. Choi KH, Moon WS. Epithelioid hemangioendothelioma of the liver. Clin Mol Hepatol, 2013, 19(3): 315-319.
4. Läuffer JM, Zimmermann A, Krähenbühl L, et al. Epithelioid hemangioendothelioma of the liver. A rare hepatic tumor. Cancer, 1996, 78(11): 2318-2327.
5. Mehrabi A, Kashfi A, Fonouni H, et al. Primary malignant hepatic epithelioid hemangioendothelioma: a comprehensive review of the literature with emphasis on the surgical therapy. Cancer, 2006, 107(9): 2108-2121.
6. Sanduzzi-Zamparelli M, Rimola J, Montironi C, et al. Hepatic epithelioid hemangioendothelioma: An international multicenter study. Dig Liver Dis, 2020, 52(9): 1041-1046.
7. Mehrabi A, Kashfi A, Schemmer P, et al. Surgical treatment of primary hepatic epithelioid hemangioendothelioma. Transplantation, 2005, 80(1 Suppl): S109-112.
8. Makhlouf HR, Ishak KG, Goodman ZD. Epithelioid hemangioendothelioma of the liver: a clinicopathologic study of 137 cases. Cancer, 1999, 85(3): 562-582.
9. Treska V, Daum O, Svajdler M, et al. Hepatic epithelioid hemangioendothelioma—a rare tumor and diagnostic dilemma. In Vivo, 2017, 31(4): 763-767.
10. Tanas MR, Sboner A, Oliveira AM, et al. Identification of a disease-defining gene fusion in epithelioid hemangioendothelioma. Sci Transl Med, 2011, 3(98): 98ra82.
11. Hu HJ, Jin YW, Jing QY, et al. Hepatic epithelioid heman-gioendothelioma: Dilemma and challenges in the preoperative diagnosis. World J Gastroenterol, 2016, 22(41): 9247-9250.
12. 刘露, 鲁亚, 刘曦娇, 等. 肝上皮样血管内皮细胞瘤的影像学表现. 中国普外基础与临床杂志, 2018, 25(2): 229-234.
13. Dong Y, Wang WP, Cantisani V, et al. Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma. World J Gastroenterol, 2016, 22(19): 4741-4749.
14. Ganeshan D, Pickhardt PJ, Morani AC, et al. Hepatic hemangioendothelioma: CT, MR, and FDG-PET-CT in 67 patients-a bi-institutional comprehensive cancer center review. Eur Radiol, 2020, 30(5): 2435-2442.
15. Dong A, Dong H, Wang Y, et al. MRI and FDG PET/CT findings of hepatic epithelioid hemangioendothelioma. Clin Nucl Med, 2013, 38(2): e66-e73.
16. Jang JK, Thomas R, Braschi-Amirfarzan M, et al. A Review of the spectrum of imaging manifestations of epithelioid heman-gioendothelioma. AJR Am J Roentgenol, 2020, 215(5): 1290-1298.
17. Wang W, Liu G, Hu P, et al. Imaging characteristics and prognostic values of hepatic epithelioid hemangioendothelioma on 18F-FDG PET/CT. Clin Exp Med, 2020, 20(4): 557-567.
18. Jeong HT, Kim MJ, Chung YE, et al. Gadoxetate disodium-enhanced MRI of mass-forming intrahepatic cholangiocarcinomas: imaging-histologic correlation. AJR Am J Roentgenol, 2013, 201(4): W603-W611.
19. Studer LL, Selby DM. Hepatic epithelioid hemangioendothelioma. Arch Pathol Lab Med, 2018, 142(2): 263-267.
20. Pichlmayr R, Weimann A, Ringe B. Indications for liver transplantation in hepatobiliary malignancy. Hepatology, 1994, 20(1 Pt 2): 33S-40S. doi: 10.1016/0270-9139(94)90271-2.
21. Remiszewski P, Szczerba E, Kalinowski P, et al. Epithelioid hemangioendothelioma of the liver as a rare indication for liver transplantation. World J Gastroenterol, 2014, 20(32): 11333-11339.
22. Marino IR, Todo S, Tzakis AG, et al. Treatment of hepatic epithelioid hemangioendothelioma with liver transplantation. Cancer, 1988, 62(10): 2079-2084.
23. Lerut JP, Orlando G, Adam R, et al. The place of liver transplantation in the treatment of hepatic epitheloid hemangioendothelioma: report of the European liver transplant registry. Ann Surg, 2007, 246(6): 949-957.
24. Otrock ZK, Al-Kutoubi A, Kattar MM, et al. Spontaneous complete regression of hepatic epithelioid haemangioendothelioma. Lancet Oncol, 2006, 7(5): 439-441.
25. Komatsu S, Iwasaki T, Demizu Y, et al. Two-stage treatment with hepatectomy and carbon-ion radiotherapy for multiple hepatic epithelioid hemangioendotheliomas. World J Gastroenterol, 2014, 20(26): 8729-8735.
26. Yousaf N, Maruzzo M, Judson I, et al. Systemic treatment options for epithelioid haemangioendothelioma: the Royal Marsden Hospital experience. Anticancer Res 35(1): 473-480.
27. Grotz TE, Nagorney D, Donohue J, et al. Hepatic epithelioid haemangioendothelioma: is transplantation the only treatment option? HPB (Oxford), 2010, 12(8): 546-553.

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Discussion on MDT of recurrent retreatment after surgery for hepatic epithelioid angioendothelioma

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