Korean J Obstet Gynecol.  2012 Jun;55(6):419-423. 10.5468/KJOG.2012.55.6.419.

Case report of undifferentiated embryonal sarcoma of a liver misdiagnosed with fallopian tube carinoma metastasis

• Kim JH
• Lee TH
• Kim HY
• Kim WG
• Kim SH

• KMID: 1783936
• DOI: http://doi.org/10.5468/KJOG.2012.55.6.419

Abstract

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare but aggressive primary tumor of the liver occurring most frequently in childhood. Its frequency in the adult population is extremely low. A 41-year-old Korean woman, who had previously undergone treatment for fallopian tube serous papillary adenocarcinoma, presented with a growing solitary mass in the right liver lobe after treatment. Although CA-125 level was normal, the mass was initially presumed to be metastasis from the primary fallopian tube carcinoma. On further examination, it was shown to be a UESL. Primary liver tumors should be considered in differential diagnoses in patients with fallopian tube cancer who subsequently raised liver tumors. This is particularly important when there is no direct evidence of recurrence of fallopian tube cancer.

Keyword

Fallopian tube carcinoma; Liver tumor; Undifferentiated embryonal sarcoma of the liver

MeSH Terms

Adenocarcinoma, Papillary
Adult
Diagnosis, Differential
Fallopian Tube Neoplasms
Fallopian Tubes
Female
Humans
Liver
Neoplasm Metastasis
Recurrence
Sarcoma

Figure

• 

  Fig. 1 (A) Newly noted metastatic nodule in the right hepatic dome (2010 November 8). (B) Aggravating process of the metastatic mass in the right hepatic lobe (2011 May 10).

• 

  Fig. 2 A segment of liver (13×8×8 cm, 161 g in toto), It shows whitish friable solid mass with hemorrhage and necrosis, which replaces near-total normal liver.

• 

  Fig. 3 Microscopic findings. (A) Atypical spindle cells with small and round or large and bizarre nuclei (H&E, ×200). (B) Strong reactivity for vimentin inspindle and polygonal or round cells and focal cytoplasmic positivity for desmin was found in some tumor cells (desmin, ×200).

Reference

1. Ou YC, Huang HY, Huang CC, Changchien CC, Tseng CW, Lin H. Primary fallopian tube carcinoma: clinicopathological analysis of 12 cases. Taiwan J Obstet Gynecol. 2011. 50:141–144.

2. Chobanian N, Dietrich CS 3rd. Ovarian cancer. Surg Clin North Am. 2008. 88:285–299.

3. Geisler JP, Geisler HE. Brain metastases in epithelial ovarian carcinoma. Gynecol Oncol. 1995. 57:246–249.

4. Rose PG, Piver MS, Tsukada Y, Lau TS. Metastatic patterns in histologic variants of ovarian cancer. An autopsy study. Cancer. 1989. 64:1508–1513.

5. Stocker JT, Ishak KG. Undifferentiated (embryonal) sarcoma of the liver: report of 31 cases. Cancer. 1978. 42:336–348.

6. Lack EE, Schloo BL, Azumi N, Travis WD, Grier HE, Kozakewich HP. Undifferentiated (embryonal) sarcoma of the liver. Clinical and pathologic study of 16 cases with emphasis on immunohistochemical features. Am J Surg Pathol. 1991. 15:1–16.

7. Kullar P, Stonard C, Jamieson N, Huguet E, Praseedom R, Jah A. Primary hepatic embryonal sarcoma masquerading as metastatic ovarian cancer. World J Surg Oncol. 2009. 7:55.

8. Psatha EA, Semelka RC, Fordham L, Firat Z, Woosley JT. Undifferentiated (embryonal) sarcoma of the liver (USL): MRI findings including dynamic gadolinium enhancement. Magn Reson Imaging. 2004. 22:897–900.

9. Baron PW, Majlessipour F, Bedros AA, Zuppan CW, Ben-Youssef R, Yanni G, et al. Undifferentiated embryonal sarcoma of the liver successfully treated with chemotherapy and liver resection. J Gastrointest Surg. 2007. 11:73–75.

10. Pachera S, Nishio H, Takahashi Y, Yokoyama Y, Oda K, Ebata T, et al. Undifferentiated embryonal sarcoma of the liver: case report and literature survey. J Hepatobiliary Pancreat Surg. 2008. 15:536–544.

11. Weitz J, Klimstra DS, Cymes K, Jarnagin WR, D'Angelica M, La Quaglia MP, et al. Management of primary liver sarcomas. Cancer. 2007. 109:1391–1396.

12. Zheng JM, Tao X, Xu AM, Chen XF, Wu MC, Zhang SH. Primary and recurrent embryonal sarcoma of the liver: clinicopathological and immunohistochemical analysis. Histopathology. 2007. 51:195–203.

13. Kiani B, Ferrell LD, Qualman S, Frankel WL. Immunohistochemical analysis of embryonal sarcoma of the liver. Appl Immunohistochem Mol Morphol. 2006. 14:193–197.

14. Walker NI, Horn MJ, Strong RW, Lynch SV, Cohen J, Ong TH, et al. Undifferentiated (embryonal) sarcoma of the liver. Pathologic findings and long-term survival after complete surgical resection. Cancer. 1992. 69:52–59.

15. Kim DY, Kim KH, Jung SE, Lee SC, Park KW, Kim WK. Undifferentiated (embryonal) sarcoma of the liver: combination treatment by surgery and chemotherapy. J Pediatr Surg. 2002. 37:1419–1423.