Diagnostic ultrasound ( PDFDrive )

CHAPTER 4 The Liver 123
A
B
C
FIG. 4.57 Classic Hepatocellular Carcinoma (HCC)
Detected on Surveillance Ultrasound. (A) Small
hypoechoic mass in the right lobe of a small cirrhotic
liver. (B) Contrast-enhanced ultrasound (CEUS) image
at the peak of arterial phase enhancement shows classic
hypervascularity. (C) CEUS image in the portal venous
phase at 2 minutes. The lesion has washed out relative
to the more enhanced liver. See also Video 4.10.
(With permission from Wilson S, Burns P. Microbubbleenhanced
US in body imaging: what role? Radiology.
2010;257[1]:24-39. 148 )
5-year survival rates of 25% to 30%, the prognosis is generally
better for ibrolamellar carcinoma than HCC. 189,190 Most patients,
however, demonstrate advanced disease at diagnosis. Aggressive
surgical resection of tumor is recommended at presentation as
well as for recurrent disease. 187 he echogenicity of ibrolamellar
carcinoma is variable. Punctate calciication and a central
echogenic scar (features that are distinctly unusual in hepatomas)
are more common in the ibrolamellar subtype.
Hemangiosarcoma (Angiosarcoma)
Hepatic hemangiosarcoma is an extremely rare malignant tumor.
It occurs almost exclusively in adults, reaching its peak incidence
in the sixth and seventh decades of life. Hemangiosarcoma is of
particular interest because of its association with speciic carcinogens:
thorotrast, arsenic, and polyvinyl chloride. Only a
few cases of hepatic hemangiosarcoma have been reported in
the radiologic literature. he sonographic appearance is a large
mass of mixed echogenicity. 191,192
Hepatic Epithelioid Hemangioendothelioma
Epithelioid hemangioendothelioma (EHE) is a rare malignant
tumor of vascular origin that occurs in adults. Sot tissues, lung,
and liver are afected. he prognosis is variable; many patients
survive longer than 5 years with or without treatment. 193 Hepatic