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Neoplasm of liver — Clinical Guidelines

Overview

Neoplasm of the liver encompasses a variety of malignant and rare benign spindle cell tumors, including unclassified malignant spindle cell neoplasms and perivascular epithelioid cell tumors (PEComas), which can occur in transplanted livers and native liver tissue respectively. 1 2

Diagnosis

Imaging studies (CT, MRI) are essential for identifying hepatic masses.

Histopathological examination is crucial for definitive diagnosis, showing features such as spindle cell morphology, nuclear pleomorphism, and specific immunohistochemical markers (e.g., EMA, vimentin, CD99, BCL2, cytokeratin).

Genetic testing (e.g., FISH for SS18 gene translocation) can help rule out specific diagnoses.

Negative findings for common genetic alterations may indicate novel or unclassified neoplasms. 1

Management

Surgical resection (e.g., hepatectomy) is indicated for localized tumors when feasible.

For unresectable tumors, hepatic artery embolization (HAE) may be used palliatively, often combined with chemotherapeutic agents.

Specific drug classes and doses are not detailed in the provided abstracts; HAE typically involves polyvinyl alcohol particulates and may include lipiodol and chemotherapy agents. 3

Special Populations

Liver Allografts: Malignant spindle cell neoplasms can arise post-transplant, necessitating vigilant surveillance. 1

Pain and Nausea Post-HAE: Patients undergoing HAE may experience significant post-procedural pain and nausea, influenced by pre-embolization liver function tests and other clinical factors. Management may involve pain control with morphine. 3

Key Recommendations

Perform comprehensive histopathological and immunohistochemical analysis for definitive diagnosis of hepatic neoplasms, especially in transplanted livers. (Evidence: Moderate 1)

Consider surgical resection for localized malignant hepatic neoplasms when appropriate. (Evidence: Expert opinion 1)

Monitor and manage post-hepatic artery embolization pain and nausea based on pre-procedural liver function tests and clinical symptoms, potentially using analgesics like morphine. (Evidence: Moderate 3)

References

1 Clevenger JA, Saxena R, Idrees MT. A de novo unclassified malignant spindle cell neoplasm of liver allograft. Archives of pathology & laboratory medicine 2014. link 2 Stenram U. Perivascular epithelioid cell tumour of the liver. World journal of gastroenterology 2008. link 3 Patel NH, Hahn D, Rapp S, Bergan K, Coldwell DM. Hepatic artery embolization: factors predisposing to postembolization pain and nausea. Journal of vascular and interventional radiology : JVIR 2000. link61377-3)

Neoplasm of liver