Hepatic Involvement in Acquired Immunodeficiency Syndrome-Associated Kaposi’s Sarcoma: A Descriptive Analysis on CT, MRI, and Ultrasound

Figures & data

Figure 1 A 46-year-old man with AIDS-related hepatic Kaposi’s sarcoma. Plain scan MRI shows multiple nodular lesions in the liver, with low signal on T1 weighted imaging (1A), high signal on T2 weighted imaging (B), slightly high signal on diffusion weighted imaging (C), and high signal on apparent diffusion coefficient imaging (D). Enhanced scanning of the arterial phase (E) showed circular enhancement, located adjacent to the portal vein and under the hepatic capsule. The portal vein phase (F) shows gradual enhancement of nodules, showing equal to slightly lower enhancement, and dilation of intrahepatic bile ducts. The delayed phase (G) shows high and equal enhancement of the nodules, with intrahepatic bile duct dilation observed. Ultrasound (H) showed multiple hypoechogenicity (arrow) in the liver, as well as thickening and enhancement of the Glisson sheath (arrowhead). After 40 days, ultrasound (I) revealed multiple hyperechoic nodules in the liver (arrows), as well as thickening and enhancement of the Glisson sheath (arrowhead). The pathological HE staining (J) of the puncture biopsy showed residual liver tissue on the left side and a tumor area on the right. The spindle shaped tumor cells were arranged in a striped pattern, with some appearing as fissures. The nucleus was ovoid, and the cells were mildly atypical. No clear mitotic image was observed (HE X200). Human herpesvirus 8 immunohistochemistry staining (K) showed partial spindle cell nucleus positivity (EnVision X200).

Table 1 The Imaging Features of AIDS-Related Hepatic Kaposi’s Sarcoma on CT, MRI, and Ultrasound

Patient No.			1	2	3	4	5	6	7	8
CT	Lesion No.		Multiple	Multiple	Multiple	Multiple	Multiple	Multiple	Multiple	Multiple
	Distribution		Mix*	Mix*	Subcapsular	Mix*	Mix*	Mix*	Mix*	Mix*
	Plain CT		Low density	Low density	Low density	Low density	Low density	Low density	Low density	Low density
CT enhancement	Arterial phase		Ring with nodular and uneven	Ring	Ring	Ring	Ring with uneven	Ring	Ring with uneven	Ring
	Portal venous and delayed phases		Gradual enhancement	Gradual enhancement	Clearer margin	Gradual enhancement	Gradual enhancement	Gradual enhancement	Gradual enhancement	Gradual enhancement
	Intrahepatic bile duct		Normal	Normal	Normal	Normal	Dilatation	Dilatation	Dilatation	Dilatation
	Bile duct wall		Normal	Normal	Normal	Normal	Thickening	Normal	Thickening	Thickening
	Lymphadenovarix		Yes	Yes	Yes	Yes	No	Yes	Yes	Yes
Ultrasound	Lesion No.		Multiple	None	None	Multiple	None	Multiple	Multiple	Multiple
	Distribution		Periportal	NA	NA	Periportal	NA	Periportal	Periportal	Periportal
	Lesion echo		Hyperecho	NA	NA	Hyperecho	NA	Hyperecho	Hypoecho	Hyperecho
	Lesion blood flow		No	NA	NA	No	NA	No	Yes	No
	Maximum oblique diameter^		125	151	135	130	125	122	187	141
	Intrahepatic bile duct		Normal	Normal	Normal	Normal	Normal	Normal	Dilatation	Dilatation
	Glisson sheath thickening		Yes	No	No	Yes	Yes	No	Yes	Yes
	Lymphadenovarix		Yes	No	Yes	Yes	No	Yes	No	No
Involved multiple body regions			Skin, oral cavity, lymph node, lung	Lymph node, lung, spleen, bone	Skin, lymph node, lung, adrenal	Skin, lymph node, oral cavity	Skin, oral cavity, bone	Skin, lymph node, lung	Skin, lymph node, lung, thyroid	Skin, lymph node, lung, spleen
Follow-up by CT		Interval	No	154	701	164	No	745	No	538
		Change	NA	Disappear	Disappear	Decrease	NA	Disappear	NA	Decrease
Follow-up by Ultrasound		Interval	No	483	66	NA	No	363	No	292
		Change	NA	No change	Decrease of lymph node	NA	NA	Disappear	NA	Decrease

Notes: *Was on behalf of the mix of periportal area and subcapsular areas. ^Was on behalf of maximum oblique diameter of right lobe of liver.

Abbreviations: NA, Not Applicable; No, No Follow-up.

Figure 2 A 30-year-old man with AIDS-related hepatic Kaposi’s sarcoma. CT plain scan shows multiple low-density nodules in the liver (A). CT enhanced scan during the arterial phase showed circular enhancement of nodular lesions, mostly located around the portal vein and a few located under the hepatic capsule (B). The portal vein phase (C) and delayed phase (D) show gradual enhancement of the nodules, with equal or slightly lower enhancement. Ultrasound (E) showed multiple hyperechoic nodules (arrows) distributed along the portal vein in the liver, with thickening of the Glisson sheath and enhanced echogenicity (arrowhead). Two years later, the CT scan (F) Showed that the original intrahepatic nodules were not shown.

Figure 3 A 41-year-old man with AIDS-related hepatic Kaposi’s sarcoma. Plain scan MRI shows multiple nodular lesions in the liver, with low signal on T1 weighted imaging (A), high signal on T2 weighted imaging (B), slightly high signal on diffusion weighted imaging (C), and high signal on apparent diffusion coefficient map (D). Enhanced scanning of the arterial phase (E) showed circular enhancement, located adjacent to the portal vein and under the hepatic capsule. The portal vein phase (F) shows gradual enhancement of nodules with equal to slightly lower enhancement. Delayed phase imaging (G) showed high and equal enhancement of the nodules, as well as intrahepatic bile duct dilation and thickening of the bile duct wall (H). Ultrasound (I) showed multiple hyperechoic nodules (arrows) distributed along the portal vein in the liver, with thickening of the Glisson sheath and enhanced echogenicity (arrowhead).