Mesenchymal hamartoma and undifferentiated embryonal sarcoma: Diagnostic keys that radiologists need to know

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A) Abdominal ultrasound shows a hypoechoic nodule (*) attached to the wall of the sigmoid colon which is penetrating into the muscularis propria with growth towards the submucosa (S), causing the lumen to collapse (arrows). B) The study using pelvic magnetic resonance imaging (transverse T2-weighted turbo spin echo [TSE] image) confirms a lesion with a nodular morphology (*) in the sigmoid colon wall, with growth towards the submucosa and hyperintense foci inside suggestive of glandular tissue. The patient required surgery and the pathology confirmed intestinal endometriosis." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.S. García, E. Lorente Martínez, T. Ripollés González, M.J. Martínez Pérez, J. Vizuete del Río" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.S." "apellidos" => "García" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Lorente Martínez" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Ripollés González" ] 3 => array:2 [ "nombre" => "M.J." 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Aineseder, M.A. Mestas Núñez, R. López Grove, M.L. Padilla, T.G. Kreindel" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Aineseder" "email" => array:1 [ 0 => "martina@aineseder.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Mestas Núñez" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "López Grove" ] 3 => array:2 [ "nombre" => "M.L." "apellidos" => "Padilla" ] 4 => array:2 [ "nombre" => "T.G." "apellidos" => "Kreindel" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hamartoma mesenquimatoso y sarcoma embrionario indiferenciado: claves diagnósticas que el radiólogo debe conocer" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 748 "Ancho" => 1755 "Tamanyo" => 226985 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Undifferentiated embryonal sarcoma. A ten-year-old female patient. History of abdominal pain and fever for a week. Normal alpha-fetoprotein levels. Ultrasound (A) showing a sizeable solid formation (star) with a heterogeneous echotexture in segment IV. Computed tomography, axial slices without contrast (B) and with intravenous contrast in portal phase (C). A sizeable heterogeneous formation can be seen with hyperdense areas corresponding to bleeding (circle), with serpiginous vessels inside (white arrows) and septa (arrow heads). A pseudocapsule is observed (dotted arrows). Magnetic resonance imaging, axial fat-saturated T2-weighted (D), diffusion and apparent diffusion coefficient b800 (E) acquisition sequences, and fat-saturated T1-weighted acquisition sequences following intravenous contrast administration in the portal phase (F). The tumour formation described can be seen, with restricted areas in diffusion (dotted circle). The septa and the pseudocapsule are more evident than on CT. The surgical specimen (G) reveals a yellowish-white tumour with lobulated borders, extensive haemorrhagic areas and a large myxoid component. Microscopy with 400x H/E staining (H) showing atypical cell proliferation made up of anaplastic cells with anisokaryosis and anisocytosis, with multiple mitoses (black circle)." ] ] ] "textoCompleto" => "General characteristicsOn detection of a focal liver lesion in a paediatric patient, it is essential to analyse the epidemiological data, including age, any previous liver disease, presence of fever or weight loss and blood test results, especially the alpha-fetoprotein (AFP) curve.In terms of diagnostic imaging, for a suspected liver lesion the first-line option is ultrasonography (US). US enables assessment of tumour characteristics, including its size, whether it is solid, cystic or mixed; involvement of adjacent structures; and, using colour Doppler, degree of vascularisation. In general, the assessment needs to be supplemented with a slice method for further characterisation and surgical planning. Magnetic resonance imaging (MRI) with dynamic sequences following gadolinium administration is preferable, as it is non-ionising and allows better tissue differentiation. If it is not available, intravenous contrast-enhanced CT with three-phase acquisition can be used.In order to plan a suitable therapeutic strategy, all these data have to be taken into account.<a class="elsevierStyleCrossRefs" href="#bib0015">3,5</a>There are data demonstrating a link between MH and UES; certain cytogenetic abnormalities occur in both tumours, such as the 19q13 chromosome aberration present in UES arising from within an MH.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> Furthermore, not only may UES have areas resembling MH, but also there may be transitional histological findings between a typical MH and UES.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a>Mesenchymal hamartomaMH is the second most common benign liver tumour in children, surpassed only by hepatic haemangioma.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> It usually occurs in children under three years of age, and around 95% are diagnosed before the age of five. It has a slight predominance in males.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>The most common forms of presentation are painless abdominal distension or a palpable mass, although cases of incidental discovery have been reported.<a class="elsevierStyleCrossRefs" href="#bib0020">4,9,10</a> Blood testing is nonspecific and usually normal, and AFP is normal or slightly elevated.MH is usually a single well-defined lesion, which can become large. It affects the right lobe in 75% of cases and may be pedunculated. It is caused by abnormal proliferation of periportal mesenchymal tissue, and comprises solid (stromal) and multi-cystic tissue.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2,4,9</a>Imaging characteristics vary depending on the composition of the lesion, which can range from almost entirely cystic to predominantly solid.On US, cystic components are anechoic with fine internal echoes, sometimes associated with mucinous material. The septa and solid portions are echogenic with poor vascularisation on colour Doppler examination. In the case of mixed MH, it takes on a “Gruyère cheese” appearance.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> In CT it is seen as a focal cystic lesion with thin septa or with a greater solid component. With intravenous contrast, its septa and solid portions are enhanced in late phases.On MRI, cystic content can be hypointense or hyperintense on T1-weighted sequences depending on the protein component, and hyperintense on T2-weighted sequences. The solid portions have low signal in T1 and T2 due to their fibrous component. With gadolinium, the septa and the solid component are slightly enhanced, similar to that seen with CT.Although most appear cystic (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) with few solid areas, others are completely solid; in these cases, they are indistinguishable from hepatoblastoma on imaging.<a class="elsevierStyleCrossRef" href="#bib0055">11</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>There may be a link between MH and UES; the latter may arise from a pre-existing MH. Therefore, many specialists believe that both may originate from an undifferentiated mesenchymal cell (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and for this reason complete surgical resection is the therapeutic procedure indicated.<a class="elsevierStyleCrossRefs" href="#bib0020">4,12</a> Although some controversial studies propose a “wait and see” approach with the hope that the lesion will spontaneously regress,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> there is evidence that MH can progress to UES over time.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Undifferentiated embryonal sarcomaUES is a rare childhood malignant tumour affecting patients from six to ten years of age with no predominance by gender or race.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a>It usually presents as an abdominal mass with or without pain or discomfort. Other nonspecific symptoms such as fever, anorexia, vomiting and diarrhoea may be present. There are also published reports of acute presentation due to spontaneous rupture.<a class="elsevierStyleCrossRefs" href="#bib0070">14–16</a> They tend to have consistently low AFP levels, except in cases in which they arise from MH, where AFP may be slightly elevated.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>The lesions are predominantly solid, large (up to 30cm) in size, solitary and well-defined with a fibrous pseudocapsule due to compression of adjacent healthy parenchyma. They are composed of sarcoma tissue in a myxoid matrix, often with areas of bleeding and necrosis. They can metastasise to the lungs, pleura, peritoneum and thymus.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>On US examination, UES behaves like a heterogeneous lesion which usually acquires a solid isoechoic or hyperechoic appearance with small anechoic areas that can be attributed to necrosis, old bleeding or cyst degeneration.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> US plays an essential role, as it may be the only method which shows the solid component of UES. CT and MRI only show its cystic nature, simulating an MH. The finding is due to the high water content of the tumour’s characteristic myxoid stroma. The discrepancy between US and CT helps guide the diagnosis.CT shows a predominantly hypodense mass with attenuation values similar to those of water (myxoid component), sectors with peripheral soft-tissue density and septa of varying thickness. Hyperdense areas that can be attributed to acute bleeding may be seen. Intravenous contrast shows mild, mostly peripheral, heterogeneous enhancement in late phases.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Serpiginous vessels observed in the arterial phase may aid in diagnosis.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Calcifications are uncommon.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>MRI is better for assessing resectability and invasion of nearby structures such as suprahepatic veins and bile ducts. It also allows for better tissue characterisation and functional evaluation, thanks to diffusion sequences and hepatospecific contrast, thereby increasing the specificity and accurate detection of the disease.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>MRI shows a fluid signal in T1- and T2-weighted sequences, with a hypointense ring (pseudocapsule) in both sequences. Hyperintense focal areas in T1 and hypointense focal areas in T2 are common in relation to areas of bleeding. With gadolinium, it shows peripheral enhancement of solid portions.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>The diffusion sequence and apparent diffusion coefficient (ADC) may be useful in assessing solid tumour areas, showing restriction. A study by Caro-Domínguez et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> showed that ADC values of less than 1.2×10−3 can be useful for distinguishing benign lesions from malignant ones.Liver biopsy is indicated for lesions in children under 6 months of age with elevated AFP (tumours other than hepatoblastoma can also increase AFP), children over 3 years of age (given the need to differentiate between hepatoblastoma and hepatocellular carcinoma) and any liver tumour lesion that does not increase AFP (as is the case of MH and UES).<a class="elsevierStyleCrossRef" href="#bib0025">5</a> However, it can be difficult to distinguish between MH, hepatoblastoma in its fetal histological variety and hepatic adenoma.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>UES is treated by surgical resection; hence, adjuvant or neoadjuvant chemotherapy may be necessary in certain cases. This new multimodal approach has markedly improved survival. At diagnosis, approximately 60% of patients have a tumour that cannot be surgically resected. In these patients, neoadjuvant therapy is useful with a view to attempting tumour resection later on. In approximately 25%–50% of patients, the lesion will remain unresectable,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> and in these cases, liver transplantation may be an option.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>Differential diagnosesMH and UES are differential diagnoses from each other in the case of a cystic lesion in a paediatric patient. Patient age should be considered, but there have been reports of overlapping age groups. UES is distinguished in the pathology examination by the common finding of bleeding and necrosis in a stroma with dysplastic cells<a class="elsevierStyleCrossRef" href="#bib0045">9</a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In patients under three years of age, hepatoblastoma is one of the main differential diagnoses. It is a solid, malignant tumour with little to moderate vascularisation. Differentiation by image examination is impossible in the case of solid MH. High levels of AFP plus a solid appearance help to diagnose hepatoblastoma. However, in some cases, AFP may be low in hepatoblastoma, and moderately high values may be found in MH (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Biopsy may not distinguish between MH and hepatoblastoma if the sample is limited to an area rich in hepatocytes.<a class="elsevierStyleCrossRef" href="#bib0105">21</a><elsevierMultimedia ident="fig0020"></elsevierMultimedia>Infantile haemangioma with myxoid changes in its stroma can also resemble MH, and occurs in the same age group.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Some 50% of cases of haemangioma present calcifications, while this is rare with MH. Furthermore, intense centripetal vascular enhancement distinguishes it from MH, which is typically hypovascular (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia>Regarding predominantly cystic MH, differential diagnoses include: simple cyst, hydatid disease, abscess and mesenteric lymphatic vascular malformation in the case of a pedunculated lesion.The distinction between MH and a simple cyst is made by the absence of internal enhancement and the wall with intravenous contrast.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>A hydatid cyst is a unilocular or multilocular cyst with defined walls. Depending on its stage, it may be anechoic on US; have fine mobile internal echoes (hydatid sand), multiple daughter vesicles inside or floating membranes; or acquire a heterogeneous structure (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). It is important to know the patient's geographic origin and blood test results such as eosinophilia, and to check with serology for Echinococcus.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> US enables UES to be distinguished from a hydatid cyst due to its solid component.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Also, unlike MH septa, daughter vesicles of a hydatid cyst do not enhance with intravenous contrast. In addition, hydatid cysts grow slowly, such that sizeable lesions are rarely found in small patients.<elsevierMultimedia ident="fig0030"></elsevierMultimedia>Liver abscesses can be differentiated from MH by the presence of fever. However, UES can present in a febrile state, probably as a result of tumour necrosis.Hepatocellular carcinoma is also considered as a differential diagnosis from UES as it occurs in the same age range, but it is distinguished by its typically solid appearance, enhancement in the arterial phase, washout and presence of a capsule in late phases. Although a history of chronic liver disease is fundamental, cirrhosis in children with hepatocellular carcinoma occurs in 20%–25% of cases.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Increased AFP levels represent another significant finding (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>).<elsevierMultimedia ident="fig0035"></elsevierMultimedia>Cystic metastases are rare in children, but they can be considered as a differential diagnosis from UES.ConclusionMH and UES share imaging characteristics, such as the presence of cystic and solid components in a single lesion, meaning they yield similar findings on microscopic examination. Whereas MH affects newborns and young children, UES affects older children. The radiologist should be familiar with the imaging characteristics of the different diseases and assess them in conjunction with other data, such as age, medical history and blood test results. This joint assessment enables a definitive diagnosis to be made. This improves the patient’s management and, as a result, the patient's prognosis.AuthorshipResponsible for study integrity: MA, TGK.Study conception: MA, RLG, TGK.Study design: MA, MAMN, RLG, TGK.Data acquisition: MA, MAMN, MLP.Data analysis and interpretation: MA, MMN, MLP.Statistical processing: N/A.Literature search: MA, MAMN, RLG, MLP.Drafting of the manuscript: MA, MAMN, RLG, MLP, TGK.Critical review of the manuscript with intellectually significant contributions: MLP, TGK.Approval of the final version: MA, MMN, RLG, MLP, TGK.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1456254" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Conclusión" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1327585" "titulo" => "Palabras clave" ] 2 => array:3 [ "identificador" => "xres1456253" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1327584" "titulo" => "Keywords" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "General characteristics" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Mesenchymal hamartoma" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Undifferentiated embryonal sarcoma" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Differential diagnoses" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Authorship" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-19" "fechaAceptado" => "2020-09-17" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1327585" "palabras" => array:6 [ 0 => "Pediatría" 1 => "Hígado" 2 => "Tumor" 3 => "Ultrasonografía" 4 => "Tomografía" 5 => "Resonancia magnética" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1327584" "palabras" => array:6 [ 0 => "Pediatrics" 1 => "Liver" 2 => "Tumor" 3 => "Ultrasonography" 4 => "Computed tomography" 5 => "Magnetic resonance imaging" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoLos tumores hepáticos son infrecuentes en la población pediátrica. Entre los más frecuentes se encuentran el hamartoma mesenquimatoso y el sarcoma embrionario indiferenciado, de diferente estirpe, pero con similitudes de imagen. El propósito de este artículo es repasar los hallazgos característicos en las imágenes y sus diagnósticos diferenciales. La ecografía es el método inicial para su estudio. La resonancia magnética y la tomografía computarizada son útiles para una mejor caracterización tumoral y planificación quirúrgica. ConclusiónEl radiólogo debe estar familiarizado con las características de imagen de las diferentes patologías y evaluarlas junto a la edad, antecedentes personales y análisis séricos del paciente." "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Conclusión" ] ] ] "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveHepatic tumors are uncommon in pediatric patients. Among the most common of these uncommon tumors are mesenchymal hamartoma and undifferentiated embryonal sarcoma, which have different origins but similar appearance on imaging studies. This paper reviews the characteristic findings and differential diagnosis of these entities. Ultrasonography is the first-line imaging test to study these tumors. Magnetic resonance imaging and computed tomography are useful for further characterizing the tumors and planning surgery. ConclusionRadiologists need to be familiar with the imaging findings of the different disease entities and to evaluate them together with the patient’s age, personal history, and bloodwork." "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Aineseder M, Mestas Núñez MA, López Grove R, Padilla ML, Kreindel TG. Hamartoma mesenquimatoso y sarcoma embrionario indiferenciado: claves diagnósticas que el radiólogo debe conocer. Radiología. 2021;63:42–49." ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 764 "Ancho" => 1755 "Tamanyo" => 214077 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Mesenchymal hamartoma. A three and a half-year-old male patient. He presented with fever and colicky abdominal pain for 5 days. Abdominal ultrasound (A). Longitudinal slice in the right lobe of the liver: a sizeable lesion can be seen, with homogeneous anechoic fluid content, thin walls and thin septa (arrow). Computed tomography of the abdomen with intravenous contrast (axial slice [B] and coronal reconstruction [C]) showing a sizeable cystic lesion with thin walls and internal septum (arrow) in the right lobe of the liver. A slight enhancement of the septum is seen in the late venous phase. Preoperative MRI with axial fat-suppressed T2-weighted (D) and fat-saturated T1-weighted (E) acquisition sequences following intravenous contrast administration in the portal phase (F). A sizeable lesion with fluid content that is hyperintense in T2 sequences and hypointense in T1 sequences can be seen. Thin septa with slight enhancement identified following administration of intravenous contrast (arrow). Surgical specimen (G) showing a cystic liver tumour lesion, with internal septa (arrows). H) Histology with 100x haematoxylin/eosin (H/E) staining showing biliary epithelium surrounded by mesenchymal tissue, separated by hepatocyte trabeculae (circle)." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 964 "Ancho" => 1755 "Tamanyo" => 222034 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Mesenchymal hamartoma with areas of undifferentiated sarcoma. A four year-old female patient. Colicky right upper quadrant abdominal pain for 2 days with a palpable abdominal mass. Normal alpha-fetoprotein. Ultrasound (A and B), axial slices. A sizeable formation with thin walls and slightly echogenic content can be seen. The caudal and cephalic sectors have two hyperechoic polypoid formations with hypoechoic pseudotubular images inside (arrows). Doppler examination (B) with no signs of vascularisation of the septa. Computed tomography with intravenous contrast, maximum intensity projection (MIP) reconstruction in arterial phase (C), axial in portal phase (D) and coronal in arterial phase (E). A sizeable, predominantly hypodense lesion is identified in the right lobe of the liver with small vascular structures (white arrows) coinciding with the posterior and cephalic vegetation reported in the ultrasound examination. Nodular enhancement in the anterior and cephalic portion (circle), greater in late phases, is also seen. Macroscopy (F) of the lesion reveals the vegetation detailed in the images (arrow)." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 748 "Ancho" => 1755 "Tamanyo" => 226985 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Undifferentiated embryonal sarcoma. A ten-year-old female patient. History of abdominal pain and fever for a week. Normal alpha-fetoprotein levels. Ultrasound (A) showing a sizeable solid formation (star) with a heterogeneous echotexture in segment IV. Computed tomography, axial slices without contrast (B) and with intravenous contrast in portal phase (C). A sizeable heterogeneous formation can be seen with hyperdense areas corresponding to bleeding (circle), with serpiginous vessels inside (white arrows) and septa (arrow heads). A pseudocapsule is observed (dotted arrows). Magnetic resonance imaging, axial fat-saturated T2-weighted (D), diffusion and apparent diffusion coefficient b800 (E) acquisition sequences, and fat-saturated T1-weighted acquisition sequences following intravenous contrast administration in the portal phase (F). The tumour formation described can be seen, with restricted areas in diffusion (dotted circle). The septa and the pseudocapsule are more evident than on CT. The surgical specimen (G) reveals a yellowish-white tumour with lobulated borders, extensive haemorrhagic areas and a large myxoid component. Microscopy with 400x H/E staining (H) showing atypical cell proliferation made up of anaplastic cells with anisokaryosis and anisocytosis, with multiple mitoses (black circle)." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 555 "Ancho" => 1305 "Tamanyo" => 77621 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Embryonal/fetal subtype hepatoblastoma. A three-year-old male patient with hepatoblastoma diagnosed in a context of peripheral precocious puberty (testosterone dose, β-hCG and alpha-fetoprotein elevated). Ultrasound, axial slice (A). The liver is seen to have a heterogeneous echotexture due to a solid lesion with defined contours, with hyperechoic and hypoechoic areas and punctiform calcifications (arrows). Computed tomography, axial slice, portal phase (B). A lesion with a mass effect and calcifications inside is seen in the right lobe of the liver. It shows slight heterogeneous enhancement following administration of intravenous contrast, with areas of lower density in relation to necrosis (arrow head). An anterior area of higher density (circle) is seen. The histology report concluded that this corresponded to an embryonal/fetal subtype hepatoblastoma." ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 668 "Ancho" => 1305 "Tamanyo" => 72274 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Rapidly involuting congenital haemangioma (RICH). A one-month-old male patient with a prenatal diagnosis of a liver tumour. Magnetic resonance imaging with coronal T2-weighted (A) and fat-saturated T1-weighted acquisition sequences following intravenous contrast administration in the portal phase (B). A sizeable tumour formation is evident; it is predominantly hyperintense in T2, with intense peripheral enhancement after gadolinium administration, and the presence of serpiginous veins (arrows)." ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 595 "Ancho" => 1305 "Tamanyo" => 58097 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Hydatid cyst. A 18-year-old female patient from an endemic area for hydatid disease. Incidental finding during ultrasound in a context of renal colic. Eosinophilia. Magnetic resonance imaging shows a heterogeneous focal image with a ring hypointense in T2 (A) and hypointense in T1 (B) in the peripheral sector of segment VIII. Apparent inner membranes (arrows) and small foci with a low-signal intensity in T1 in its most cephalic portion (circle) are seen and interpreted as calcifications. The patient was treated with albendazole and the cyst was deroofed." ] ] 6 => array:8 [ "identificador" => "fig0035" "etiqueta" => "Fig. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 413 "Ancho" => 1305 "Tamanyo" => 59358 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Hepatocellular carcinoma. A 12-year-old male patient with no significant medical history. Abdominal pain and jaundice. Hard stone-like tumour in right iliac fossa. Alpha-fetoprotein: 10,000 U/l. Magnetic resonance imaging: axial fat-saturated T1-weighted acquisition sequences following administration of intravenous contrast in arterial phases (A) and after 3min (B): a sizeable tumour formation is seen in the right lobe of the liver showing enhanced areas in the arterial phase (white arrows) and a pseudocapsule in acquisitions at 3min (B, dotted arrows). Other smaller tumour formations are seen in the left lobe of the liver (arrow heads). Splenomegaly (asterisk). The patient underwent transplantation, with a good outcome." ] ] 7 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "DD: differential diagnosis; F: female; HB: hepatoblastoma; HCC: hepatocellular carcinoma; M: male; MH: mesenchymal hamartoma; UES: undifferentiated embryonal sarcoma." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Differential diagnoses</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MH \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UES \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Congenital haemangioma \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HB \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HCC \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hydatid cyst \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidemiology age sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Newborns <3−5 years M>F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6−10 years F=M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Newborns <1 year F>M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Newborns <5 years M>F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10−14 years M>F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Any age peak: 9−17 years Endemic area \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AFP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal/slightly elevated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal; in UES arising from MH, may be elevated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elevated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elevated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal AFP Eosinophilia Serology Echinococcus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">US \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cystic: anechoic with internal septa Solid: hyperechoic colour Doppler + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solid mass with cystic areas. Hyperechoic. Heterogeneous (myxoid stroma, blood debris) colour Doppler + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solid. Hypoechoic/hyperechoic Doppler+++ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mostly hyperechoic Doppler + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypoechoic solid nodule \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unilocular or multilocular cyst. Fine mobile internal echoes, daughter vesicles, membranes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cystic lesion, septa or solid component Solid variant: indistinguishable from hepatoblastoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cystic appearance (discrepant with ultrasound). Septa, nodules Possibly bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypodense, possibly calcifications, hypodense fibronecrotic centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Well-defined mass 50% calcifications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heterogeneous hypodense capsule formation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="middle">Cystic image with septa (DD with MH) Slow growth: large lesions are uncommon in small patients (DD MH)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cystic: hypointense or hyperintense in T1 sequences (due to protein component), hyperintense in T2 Solid: low signal in T1 and T2 due to fibrous component. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solid cystic formation Pseudocapsule in T1: bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypointense in T1, hyperintense in T2 and in diffusion. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shunts: flow vacuum. Hypointense fibronecrotic centre in T1 and T2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypointense in T1, hyperintense in T2. Echo gradient useful for assessing vascular invasion. Heterogeneous formation. Hypointense capsule. Restriction in diffusion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contrast enhancement: intensity. Times \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Slight enhancement of the septa and the solid component; enhancement of its septa and solid portions in late phases. Little/moderate delayed enhancement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Little/moderate delayed enhancement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial: intense peripheral enhancement. Centripetal filling in successive phases Sizeable lesions: fibronecrotic centre, lack of enhancement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Less enhancement than adjacent parenchyma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heterogeneous arterial enhancement with washout in portal phase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Enhancement of walls but not of septa \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2505144.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison table of mesenchymal hamartoma, undifferentiated embryonal sarcoma and other differential diagnoses." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "From the archives of the AFIP: pediatric liver masses: radiologic-pathologic correlation part 2. 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Radiology through images

Hamartoma mesenquimatoso y sarcoma embrionario indiferenciado: claves diagnósticas que el radiólogo debe conocer

M. Aineseder

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martina@aineseder.com

Corresponding author.

, M.A. Mestas Núñez, R. López Grove, M.L. Padilla, T.G. Kreindel

Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

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Magnetic resonance imaging &#40;MRI&#41; with dynamic sequences following gadolinium administration is preferable&#44; as it is non-ionising and allows better tissue differentiation&#46; If it is not available&#44; intravenous contrast-enhanced CT with three-phase acquisition can be used&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to plan a suitable therapeutic strategy&#44; all these data have to be taken into account&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are data demonstrating a link between MH and UES&#59; certain cytogenetic abnormalities occur in both tumours&#44; such as the 19q13 chromosome aberration present in UES arising from within an MH&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Furthermore&#44; not only may UES have areas resembling MH&#44; but also there may be transitional histological findings between a typical MH and UES&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Mesenchymal hamartoma</span><p id="par0025" class="elsevierStylePara elsevierViewall">MH is the second most common benign liver tumour in children&#44; surpassed only by hepatic haemangioma&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> It usually occurs in children under three years of age&#44; and around 95&#37; are diagnosed before the age of five&#46; It has a slight predominance in males&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The most common forms of presentation are painless abdominal distension or a palpable mass&#44; although cases of incidental discovery have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;9&#44;10</span></a> Blood testing is nonspecific and usually normal&#44; and AFP is normal or slightly elevated&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">MH is usually a single well-defined lesion&#44; which can become large&#46; It affects the right lobe in 75&#37; of cases and may be pedunculated&#46; It is caused by abnormal proliferation of periportal mesenchymal tissue&#44; and comprises solid &#40;stromal&#41; and multi-cystic tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Imaging characteristics vary depending on the composition of the lesion&#44; which can range from almost entirely cystic to predominantly solid&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">On US&#44; cystic components are anechoic with fine internal echoes&#44; sometimes associated with mucinous material&#46; The septa and solid portions are echogenic with poor vascularisation on colour Doppler examination&#46; In the case of mixed MH&#44; it takes on a &#8220;Gruy&#232;re cheese&#8221; appearance&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In CT it is seen as a focal cystic lesion with thin septa or with a greater solid component&#46; With intravenous contrast&#44; its septa and solid portions are enhanced in late phases&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">On MRI&#44; cystic content can be hypointense or hyperintense on T1-weighted sequences depending on the protein component&#44; and hyperintense on T2-weighted sequences&#46; The solid portions have low signal in T1 and T2 due to their fibrous component&#46; With gadolinium&#44; the septa and the solid component are slightly enhanced&#44; similar to that seen with CT&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although most appear cystic &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; with few solid areas&#44; others are completely solid&#59; in these cases&#44; they are indistinguishable from hepatoblastoma on imaging&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">There may be a link between MH and UES&#59; the latter may arise from a pre-existing MH&#46; Therefore&#44; many specialists believe that both may originate from an undifferentiated mesenchymal cell &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; and for this reason complete surgical resection is the therapeutic procedure indicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;12</span></a> Although some controversial studies propose a &#8220;wait and see&#8221; approach with the hope that the lesion will spontaneously regress&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> there is evidence that MH can progress to UES over time&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Undifferentiated embryonal sarcoma</span><p id="par0065" class="elsevierStylePara elsevierViewall">UES is a rare childhood malignant tumour affecting patients from six to ten years of age with no predominance by gender or race&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It usually presents as an abdominal mass with or without pain or discomfort&#46; Other nonspecific symptoms such as fever&#44; anorexia&#44; vomiting and diarrhoea may be present&#46; There are also published reports of acute presentation due to spontaneous rupture&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a> They tend to have consistently low AFP levels&#44; except in cases in which they arise from MH&#44; where AFP may be slightly elevated&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The lesions are predominantly solid&#44; large &#40;up to 30<span class="elsevierStyleHsp" style=""></span>cm&#41; in size&#44; solitary and well-defined with a fibrous pseudocapsule due to compression of adjacent healthy parenchyma&#46; They are composed of sarcoma tissue in a myxoid matrix&#44; often with areas of bleeding and necrosis&#46; They can metastasise to the lungs&#44; pleura&#44; peritoneum and thymus&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">On US examination&#44; UES behaves like a heterogeneous lesion which usually acquires a solid isoechoic or hyperechoic appearance with small anechoic areas that can be attributed to necrosis&#44; old bleeding or cyst degeneration&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> US plays an essential role&#44; as it may be the only method which shows the solid component of UES&#46; CT and MRI only show its cystic nature&#44; simulating an MH&#46; The finding is due to the high water content of the tumour&#8217;s characteristic myxoid stroma&#46; The discrepancy between US and CT helps guide the diagnosis&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">CT shows a predominantly hypodense mass with attenuation values similar to those of water &#40;myxoid component&#41;&#44; sectors with peripheral soft-tissue density and septa of varying thickness&#46; Hyperdense areas that can be attributed to acute bleeding may be seen&#46; Intravenous contrast shows mild&#44; mostly peripheral&#44; heterogeneous enhancement in late phases&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Serpiginous vessels observed in the arterial phase may aid in diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Calcifications are uncommon&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">MRI is better for assessing resectability and invasion of nearby structures such as suprahepatic veins and bile ducts&#46; It also allows for better tissue characterisation and functional evaluation&#44; thanks to diffusion sequences and hepatospecific contrast&#44; thereby increasing the specificity and accurate detection of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">MRI shows a fluid signal in T1- and T2-weighted sequences&#44; with a hypointense ring &#40;pseudocapsule&#41; in both sequences&#46; Hyperintense focal areas in T1 and hypointense focal areas in T2 are common in relation to areas of bleeding&#46; With gadolinium&#44; it shows peripheral enhancement of solid portions&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The diffusion sequence and apparent diffusion coefficient &#40;ADC&#41; may be useful in assessing solid tumour areas&#44; showing restriction&#46; A study by Caro-Dom&#237;nguez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> showed that ADC values of less than 1&#46;2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">&#8722;3</span> can be useful for distinguishing benign lesions from malignant ones&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Liver biopsy is indicated for lesions in children under 6 months of age with elevated AFP &#40;tumours other than hepatoblastoma can also increase AFP&#41;&#44; children over 3 years of age &#40;given the need to differentiate between hepatoblastoma and hepatocellular carcinoma&#41; and any liver tumour lesion that does not increase AFP &#40;as is the case of MH and UES&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; it can be difficult to distinguish between MH&#44; hepatoblastoma in its fetal histological variety and hepatic adenoma&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">UES is treated by surgical resection&#59; hence&#44; adjuvant or neoadjuvant chemotherapy may be necessary in certain cases&#46; This new multimodal approach has markedly improved survival&#46; At diagnosis&#44; approximately 60&#37; of patients have a tumour that cannot be surgically resected&#46; In these patients&#44; neoadjuvant therapy is useful with a view to attempting tumour resection later on&#46; In approximately 25&#37;&#8211;50&#37; of patients&#44; the lesion will remain unresectable&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and in these cases&#44; liver transplantation may be an option&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Differential diagnoses</span><p id="par0115" class="elsevierStylePara elsevierViewall">MH and UES are differential diagnoses from each other in the case of a cystic lesion in a paediatric patient&#46; Patient age should be considered&#44; but there have been reports of overlapping age groups&#46; UES is distinguished in the pathology examination by the common finding of bleeding and necrosis in a stroma with dysplastic cells<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">In patients under three years of age&#44; hepatoblastoma is one of the main differential diagnoses&#46; It is a solid&#44; malignant tumour with little to moderate vascularisation&#46; Differentiation by image examination is impossible in the case of solid MH&#46; High levels of AFP plus a solid appearance help to diagnose hepatoblastoma&#46; However&#44; in some cases&#44; AFP may be low in hepatoblastoma&#44; and moderately high values may be found in MH &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Biopsy may not distinguish between MH and hepatoblastoma if the sample is limited to an area rich in hepatocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Infantile haemangioma with myxoid changes in its stroma can also resemble MH&#44; and occurs in the same age group&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Some 50&#37; of cases of haemangioma present calcifications&#44; while this is rare with MH&#46; Furthermore&#44; intense centripetal vascular enhancement distinguishes it from MH&#44; which is typically hypovascular &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Regarding predominantly cystic MH&#44; differential diagnoses include&#58; simple cyst&#44; hydatid disease&#44; abscess and mesenteric lymphatic vascular malformation in the case of a pedunculated lesion&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The distinction between MH and a simple cyst is made by the absence of internal enhancement and the wall with intravenous contrast&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">A hydatid cyst is a unilocular or multilocular cyst with defined walls&#46; Depending on its stage&#44; it may be anechoic on US&#59; have fine mobile internal echoes &#40;hydatid sand&#41;&#44; multiple daughter vesicles inside or floating membranes&#59; or acquire a heterogeneous structure &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; It is important to know the patient&#39;s geographic origin and blood test results such as eosinophilia&#44; and to check with serology for <span class="elsevierStyleItalic">Echinococcus</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> US enables UES to be distinguished from a hydatid cyst due to its solid component&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Also&#44; unlike MH septa&#44; daughter vesicles of a hydatid cyst do not enhance with intravenous contrast&#46; In addition&#44; hydatid cysts grow slowly&#44; such that sizeable lesions are rarely found in small patients&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Liver abscesses can be differentiated from MH by the presence of fever&#46; However&#44; UES can present in a febrile state&#44; probably as a result of tumour necrosis&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Hepatocellular carcinoma is also considered as a differential diagnosis from UES as it occurs in the same age range&#44; but it is distinguished by its typically solid appearance&#44; enhancement in the arterial phase&#44; washout and presence of a capsule in late phases&#46; Although a history of chronic liver disease is fundamental&#44; cirrhosis in children with hepatocellular carcinoma occurs in 20&#37;&#8211;25&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Increased AFP levels represent another significant finding &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Cystic metastases are rare in children&#44; but they can be considered as a differential diagnosis from UES&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0160" class="elsevierStylePara elsevierViewall">MH and UES share imaging characteristics&#44; such as the presence of cystic and solid components in a single lesion&#44; meaning they yield similar findings on microscopic examination&#46; Whereas MH affects newborns and young children&#44; UES affects older children&#46; The radiologist should be familiar with the imaging characteristics of the different diseases and assess them in conjunction with other data&#44; such as age&#44; medical history and blood test results&#46; This joint assessment enables a definitive diagnosis to be made&#46; This improves the patient&#8217;s management and&#44; as a result&#44; the patient&#39;s prognosis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Authorship</span><p id="par0165" class="elsevierStylePara elsevierViewall">Responsible for study integrity&#58; MA&#44; TGK&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Study conception&#58; MA&#44; RLG&#44; TGK&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Study design&#58; MA&#44; MAMN&#44; RLG&#44; TGK&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Data acquisition&#58; MA&#44; MAMN&#44; MLP&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; MA&#44; MMN&#44; MLP&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Statistical processing&#58; N&#47;A&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Literature search&#58; MA&#44; MAMN&#44; RLG&#44; MLP&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Drafting of the manuscript&#58; MA&#44; MAMN&#44; RLG&#44; MLP&#44; TGK&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually significant contributions&#58; MLP&#44; TGK&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Approval of the final version&#58; MA&#44; MMN&#44; RLG&#44; MLP&#44; TGK&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Mesenchymal hamartoma"
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          "titulo" => "Undifferentiated embryonal sarcoma"
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            0 => "Pediatr&#237;a"
            1 => "H&#237;gado"
            2 => "Tumor"
            3 => "Ultrasonograf&#237;a"
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            5 => "Resonancia magn&#233;tica"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los tumores hep&#225;ticos son infrecuentes en la poblaci&#243;n pedi&#225;trica&#46; Entre los m&#225;s frecuentes se encuentran el hamartoma mesenquimatoso y el sarcoma embrionario indiferenciado&#44; de diferente estirpe&#44; pero con similitudes de imagen&#46; El prop&#243;sito de este art&#237;culo es repasar los hallazgos caracter&#237;sticos en las im&#225;genes y sus diagn&#243;sticos diferenciales&#46; La ecograf&#237;a es el m&#233;todo inicial para su estudio&#46; La resonancia magn&#233;tica y la tomograf&#237;a computarizada son &#250;tiles para una mejor caracterizaci&#243;n tumoral y planificaci&#243;n quir&#250;rgica&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusi&#243;n</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El radi&#243;logo debe estar familiarizado con las caracter&#237;sticas de imagen de las diferentes patolog&#237;as y evaluarlas junto a la edad&#44; antecedentes personales y an&#225;lisis s&#233;ricos del paciente&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Objective</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Hepatic tumors are uncommon in pediatric patients&#46; Among the most common of these uncommon tumors are mesenchymal hamartoma and undifferentiated embryonal sarcoma&#44; which have different origins but similar appearance on imaging studies&#46; This paper reviews the characteristic findings and differential diagnosis of these entities&#46; Ultrasonography is the first-line imaging test to study these tumors&#46; Magnetic resonance imaging and computed tomography are useful for further characterizing the tumors and planning surgery&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Radiologists need to be familiar with the imaging findings of the different disease entities and to evaluate them together with the patient&#8217;s age&#44; personal history&#44; and bloodwork&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mesenchymal hamartoma&#46; A three and a half-year-old male patient&#46; He presented with fever and colicky abdominal pain for 5 days&#46; Abdominal ultrasound &#40;A&#41;&#46; Longitudinal slice in the right lobe of the liver&#58; a sizeable lesion can be seen&#44; with homogeneous anechoic fluid content&#44; thin walls and thin septa &#40;arrow&#41;&#46; Computed tomography of the abdomen with intravenous contrast &#40;axial slice &#91;B&#93; and coronal reconstruction &#91;C&#93;&#41; showing a sizeable cystic lesion with thin walls and internal septum &#40;arrow&#41; in the right lobe of the liver&#46; A slight enhancement of the septum is seen in the late venous phase&#46; Preoperative MRI with axial fat-suppressed T2-weighted &#40;D&#41; and fat-saturated T1-weighted &#40;E&#41; acquisition sequences following intravenous contrast administration in the portal phase &#40;F&#41;&#46; A sizeable lesion with fluid content that is hyperintense in T2 sequences and hypointense in T1 sequences can be seen&#46; Thin septa with slight enhancement identified following administration of intravenous contrast &#40;arrow&#41;&#46; Surgical specimen &#40;G&#41; showing a cystic liver tumour lesion&#44; with internal septa &#40;arrows&#41;&#46; H&#41; Histology with 100x haematoxylin&#47;eosin &#40;H&#47;E&#41; staining showing biliary epithelium surrounded by mesenchymal tissue&#44; separated by hepatocyte trabeculae &#40;circle&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 964
            "Ancho" => 1755
            "Tamanyo" => 222034
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mesenchymal hamartoma with areas of undifferentiated sarcoma&#46; A four year-old female patient&#46; Colicky right upper quadrant abdominal pain for 2 days with a palpable abdominal mass&#46; Normal alpha-fetoprotein&#46; Ultrasound &#40;A and B&#41;&#44; axial slices&#46; A sizeable formation with thin walls and slightly echogenic content can be seen&#46; The caudal and cephalic sectors have two hyperechoic polypoid formations with hypoechoic pseudotubular images inside &#40;arrows&#41;&#46; Doppler examination &#40;B&#41; with no signs of vascularisation of the septa&#46; Computed tomography with intravenous contrast&#44; maximum intensity projection &#40;MIP&#41; reconstruction in arterial phase &#40;C&#41;&#44; axial in portal phase &#40;D&#41; and coronal in arterial phase &#40;E&#41;&#46; A sizeable&#44; predominantly hypodense lesion is identified in the right lobe of the liver with small vascular structures &#40;white arrows&#41; coinciding with the posterior and cephalic vegetation reported in the ultrasound examination&#46; Nodular enhancement in the anterior and cephalic portion &#40;circle&#41;&#44; greater in late phases&#44; is also seen&#46; Macroscopy &#40;F&#41; of the lesion reveals the vegetation detailed in the images &#40;arrow&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 748
            "Ancho" => 1755
            "Tamanyo" => 226985
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Undifferentiated embryonal sarcoma&#46; A ten-year-old female patient&#46; History of abdominal pain and fever for a week&#46; Normal alpha-fetoprotein levels&#46; Ultrasound &#40;A&#41; showing a sizeable solid formation &#40;star&#41; with a heterogeneous echotexture in segment IV&#46; Computed tomography&#44; axial slices without contrast &#40;B&#41; and with intravenous contrast in portal phase &#40;C&#41;&#46; A sizeable heterogeneous formation can be seen with hyperdense areas corresponding to bleeding &#40;circle&#41;&#44; with serpiginous vessels inside &#40;white arrows&#41; and septa &#40;arrow heads&#41;&#46; A pseudocapsule is observed &#40;dotted arrows&#41;&#46; Magnetic resonance imaging&#44; axial fat-saturated T2-weighted &#40;D&#41;&#44; diffusion and apparent diffusion coefficient b800 &#40;E&#41; acquisition sequences&#44; and fat-saturated T1-weighted acquisition sequences following intravenous contrast administration in the portal phase &#40;F&#41;&#46; The tumour formation described can be seen&#44; with restricted areas in diffusion &#40;dotted circle&#41;&#46; The septa and the pseudocapsule are more evident than on CT&#46; The surgical specimen &#40;G&#41; reveals a yellowish-white tumour with lobulated borders&#44; extensive haemorrhagic areas and a large myxoid component&#46; Microscopy with 400x H&#47;E staining &#40;H&#41; showing atypical cell proliferation made up of anaplastic cells with anisokaryosis and anisocytosis&#44; with multiple mitoses &#40;black circle&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 555
            "Ancho" => 1305
            "Tamanyo" => 77621
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Embryonal&#47;fetal subtype hepatoblastoma&#46; A three-year-old male patient with hepatoblastoma diagnosed in a context of peripheral precocious puberty &#40;testosterone dose&#44; &#946;-hCG and alpha-fetoprotein elevated&#41;&#46; Ultrasound&#44; axial slice &#40;A&#41;&#46; The liver is seen to have a heterogeneous echotexture due to a solid lesion with defined contours&#44; with hyperechoic and hypoechoic areas and punctiform calcifications &#40;arrows&#41;&#46; Computed tomography&#44; axial slice&#44; portal phase &#40;B&#41;&#46; A lesion with a mass effect and calcifications inside is seen in the right lobe of the liver&#46; It shows slight heterogeneous enhancement following administration of intravenous contrast&#44; with areas of lower density in relation to necrosis &#40;arrow head&#41;&#46; An anterior area of higher density &#40;circle&#41; is seen&#46; The histology report concluded that this corresponded to an embryonal&#47;fetal subtype hepatoblastoma&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Fig&#46; 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 668
            "Ancho" => 1305
            "Tamanyo" => 72274
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0050"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Rapidly involuting congenital haemangioma &#40;RICH&#41;&#46; A one-month-old male patient with a prenatal diagnosis of a liver tumour&#46; Magnetic resonance imaging with coronal T2-weighted &#40;A&#41; and fat-saturated T1-weighted acquisition sequences following intravenous contrast administration in the portal phase &#40;B&#41;&#46; A sizeable tumour formation is evident&#59; it is predominantly hyperintense in T2&#44; with intense peripheral enhancement after gadolinium administration&#44; and the presence of serpiginous veins &#40;arrows&#41;&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig0030"
        "etiqueta" => "Fig&#46; 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 595
            "Ancho" => 1305
            "Tamanyo" => 58097
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0055"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hydatid cyst&#46; A 18-year-old female patient from an endemic area for hydatid disease&#46; Incidental finding during ultrasound in a context of renal colic&#46; Eosinophilia&#46; Magnetic resonance imaging shows a heterogeneous focal image with a ring hypointense in T2 &#40;A&#41; and hypointense in T1 &#40;B&#41; in the peripheral sector of segment VIII&#46; Apparent inner membranes &#40;arrows&#41; and small foci with a low-signal intensity in T1 in its most cephalic portion &#40;circle&#41; are seen and interpreted as calcifications&#46; The patient was treated with albendazole and the cyst was deroofed&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig0035"
        "etiqueta" => "Fig&#46; 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 413
            "Ancho" => 1305
            "Tamanyo" => 59358
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0060"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Hepatocellular carcinoma&#46; A 12-year-old male patient with no significant medical history&#46; Abdominal pain and jaundice&#46; Hard stone-like tumour in right iliac fossa&#46; Alpha-fetoprotein&#58; 10&#44;000 U&#47;l&#46; Magnetic resonance imaging&#58; axial fat-saturated T1-weighted acquisition sequences following administration of intravenous contrast in arterial phases &#40;A&#41; and after 3<span class="elsevierStyleHsp" style=""></span>min &#40;B&#41;&#58; a sizeable tumour formation is seen in the right lobe of the liver showing enhanced areas in the arterial phase &#40;white arrows&#41; and a pseudocapsule in acquisitions at 3<span class="elsevierStyleHsp" style=""></span>min &#40;B&#44; dotted arrows&#41;&#46; Other smaller tumour formations are seen in the left lobe of the liver &#40;arrow heads&#41;&#46; Splenomegaly &#40;asterisk&#41;&#46; The patient underwent transplantation&#44; with a good outcome&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0065"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">DD&#58; differential diagnosis&#59; F&#58; female&#59; HB&#58; hepatoblastoma&#59; HCC&#58; hepatocellular carcinoma&#59; M&#58; male&#59; MH&#58; mesenchymal hamartoma&#59; UES&#58; undifferentiated embryonal sarcoma&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Differential diagnoses</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Congenital haemangioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hydatid cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidemiology age sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Newborns &#60;3&#8722;5 years M<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8722;10 years F<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Newborns &#60;1 year F<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Newborns &#60;5 years M<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8722;14 years M<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Any age peak&#58; 9&#8722;17 years Endemic area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AFP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47;slightly elevated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#59; in UES arising from MH&#44; may be elevated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal AFP Eosinophilia Serology Echinococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">US&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cystic&#58; anechoic with internal septa Solid&#58; hyperechoic colour Doppler &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Solid mass with cystic areas&#46; Hyperechoic&#46; Heterogeneous &#40;myxoid stroma&#44; blood debris&#41; colour Doppler &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Solid&#46; Hypoechoic&#47;hyperechoic Doppler&#43;&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mostly hyperechoic Doppler &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypoechoic solid nodule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unilocular or multilocular cyst&#46; Fine mobile internal echoes&#44; daughter vesicles&#44; membranes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cystic lesion&#44; septa or solid component Solid variant&#58; indistinguishable from hepatoblastoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cystic appearance &#40;discrepant with ultrasound&#41;&#46; Septa&#44; nodules Possibly bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypodense&#44; possibly calcifications&#44; hypodense fibronecrotic centre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Well-defined mass 50&#37; calcifications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heterogeneous hypodense capsule formation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Cystic image with septa &#40;DD with MH&#41; Slow growth&#58; large lesions are uncommon in small patients &#40;DD MH&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cystic&#58; hypointense or hyperintense in T1 sequences &#40;due to protein component&#41;&#44; hyperintense in T2 Solid&#58; low signal in T1 and T2 due to fibrous component&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Solid cystic formation Pseudocapsule in T1&#58; bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypointense in T1&#44; hyperintense in T2 and in diffusion&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shunts&#58; flow vacuum&#46; Hypointense fibronecrotic centre in T1 and T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypointense in T1&#44; hyperintense in T2&#46; Echo gradient useful for assessing vascular invasion&#46; Heterogeneous formation&#46; Hypointense capsule&#46; Restriction in diffusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contrast enhancement&#58; intensity&#46; Times&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Slight enhancement of the septa and the solid component&#59; enhancement of its septa and solid portions in late phases&#46; Little&#47;moderate delayed enhancement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Little&#47;moderate delayed enhancement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial&#58; intense peripheral enhancement&#46; Centripetal filling in successive phases Sizeable lesions&#58; fibronecrotic centre&#44; lack of enhancement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Less enhancement than adjacent parenchyma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heterogeneous arterial enhancement with washout in portal phase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enhancement of walls but not of septa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Comparison table of mesenchymal hamartoma&#44; undifferentiated embryonal sarcoma and other differential diagnoses&#46;</p>"
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2020.12.002

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