R A D I O L O G I C A L C A S E
Primary hemangiopericytoma
of the liver
Timothy Oppermann, MD, Harry W. Sell, Jr., MD, FACS, Margaret A. Miller, MD,
and Kurt R. Stahlfeld, MD, FACS
CASE SUMMARY
A 59-year-old man presented to his
primary care physician with a 10 lb
weight loss and a slowly enlarging
abdominal mass. He denied any gas-
trointestinal symptoms, cirrhosis,
hepatitis, overseas travel or exposure
to toxins. His past medical history was
significant for hypertension and ane-
mia. The only notable finding on phys-
ical exam was a large, right upper
quadrant abdominal mass. Computed
tomography (CT, Figure 1) and mag-
netic resonance imaging (MRI, Figure
2) were performed. Carcinoembryonic
antigen (CEA), cancer antigen (CA 19-
9) and alpha-fetoprotein levels were
normal.
IMAGING FINDINGS
Large heterogeneous lesions of the
liver are rarely resectable for cure. FIGURE 1. Coronal reformatted contrast-enhanced CT image shows a large, sharply mar-
However, the CT findings demon- ginated heterogenous mass, with cystic areas, in the left lobe of the liver. The mass dis-
strated no invasion of adjacent struc- places the left portal vein laterally. A simple cyst is present in the right lobe. (Arterial phase
tures, no significant adenopathy and no demonstrates hypervascularity in the wall of the mass.)
evidence of malignancy. Additionally,
the enhancement characteristics on giopericytoma. Resection margins and DIAGNOSIS
MRI were not classic for hepatocellu- lymph nodes were negative for tumor. Primary hemangiopericytoma of the
lar carcinoma. Although the possibility The mass stained positive for CD99 liver
of cure and the diagnosis were in and Bcl2, weakly positive for CD34
doubt, the patient underwent diagnos- and smooth muscle actin, and negative DISCUSSION
tic laparoscopy, laparotomy and left for CD31 and EMA. This pattern is Hemangiopericytoma, first described
lateral segmentectomy (seg. 2 and 3). consistent with a hemangiopericytoma and named by Stout and Murray in
Pathology revealed a 21 cm heman- (solitary fibrous tumor.) 1942,1 is an uncommon spindle-cell
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