Imaging findings of hepatic epithelioid hemangioendothelioma and fibrolamellar hepatocellular carcinoma: a critical appraisal of current literature about imaging features of two rare liver cancers

Lorenzo Mulazzani, Margherita Alvisi


Hepatic epithelioid hemangioendothelioma (HEHE) and fibrolamellar hepatocellular carcinoma (HCC) are rare malignant neoplasms of the liver. Contrarily to HCC, no distinctive imaging criteria based on contrast enhancement pattern are known for these neoplasms, thus they are frequently misdiagnosed as other liver tumors. Due to their infrequency, very few data principally based on reports of few patients are currently available in literature. This results in several issues pending on the application of imaging in the diagnosis of these cancers, which absolutely needs pathological examination. Nevertheless, imaging techniques are fundamental in the diagnostic work-up and in the management of affected patient. This review summarizes the current evidence about imaging systems in the diagnosis of HEHE and fibrolamellar carcinoma (FLC), discussing the significance of the principal iconographic hallmarks and the prospective potentials of the most employed techniques.