PMC3806680_01
At the time of initial diagnosis, liver parenchyma was patent and showed no secondary signs of metastasis.
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F1
At the onset of the known disease 4 months earlier, the liver, especially in a routine CT scan, showed no pathological signs or liver metastasis (fig. 1).
Four months after the final diagnosis of bronchial carcinoma, the patient showed a rapid elevation of liver enzymes. In the contrast-enhanced CT scan, a clear perfusion defect can be seen in liver segments 5 and 6 (arrow), which was initially assumed to be fatty liver during chemotherapy.
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F2
Segmental hypointensity was found in the venous phase in segments 5 and 6, without any occlusion of the central portal vein and hepatic artery (fig. 2).
a The B-mode image shows discrete hyperechogenicity within liver segments 5 and 6 (arrow). b Power Doppler in the same slice shows slightly reduced perfusion of the vessels in the periphery.
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F3
The normal B-mode ultrasound shows discrete hyperechogenic regions (fig. 3a). The additionally performed power Doppler showed reduced vessels in the periphery of segments 5 and 6 (fig. 3b).
a After contrast medium application, we observed strongly reduced perfusion in segments 5 and 6 in the early arterial phase, which was clearly separated (arrow) from the normal liver tissue. b In the very late phase, there was no significant washout, which led us to suppose that this area could also have a perfusion deficit without typical malignant behavior.
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F4
After applying a contrast medium, there were clear signs of perfusion deficiency in the early arterial phase without washout in the late phase (fig. 4a, b).
Image showing colorization with HE staining. Arrows show the triangular portal triad. The small blue cells are malignant cells, which clearly infiltrate the surrounding tissue in the portal triad (arrowhead). Furthermore, there are some malignant cells within the portal vein inside the portal triad (asterisk). There is only an isolated malignant infiltration of the portal triad without parenchymal metastasis within the liver.
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F5
There were also some small metastatic cells within the small portal veins (fig. 5).