PMC3506902_01
CT scan showing mass lesion in segment 4 abutting the left branch of portal vein.
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fig1
Computerized Tomography (CT) of the abdomen showed a 4.1 x 3.7 cm heterogeneously enhancing mass lesion in segment IV of liver abutting the left branch of portal vein (Figure 1).
MRCP showing a filling defect in the left hepatic duct.
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fig2
A Magnetic Resonance Imaging (MRI) of upper abdomen with Magnetic Resonance CholagioPancreaticography (MRCP) showed a filling defect in the left hepatic duct with lesion in the adjacent part of liver in segment IV, suggestive of a left hepatic duct tumor with infiltration in the liver (Figure 2).
Intraoperative picture showing tumor arising from the left hepatic duct. CBD hooked in yellow, hepatic artery in red, and portal vein in blue.
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fig3
Intraopertaively a lesion arising from the left hepatic duct involving the left branch of portal vein and extending upto the portal confluence was found (Figure 3) rendering the tumor unresectable.
Histopathology showing a typical rosette appearance of neuroendocrine tumor.
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fig4
Histopathology showed typical rosette appearance of a neuroendocrine tumor (Figure 4) and immunohistochemistry positive for CD56, Chromogranin and Synaptophysin (Figure 5).
Immunohistochemistry staining positive for Chromogranin (a) and Synaptophysin (b).
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fig5
Histopathology showed typical rosette appearance of a neuroendocrine tumor (Figure 4) and immunohistochemistry positive for CD56, Chromogranin and Synaptophysin (Figure 5).
Electron microscopy picture showing multiple granules of varying sizes.
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fig6
Ultrastructural study of the cell with electron microscopy (Figure 6) showed the presence of multiple neurosecretory granules with muscle tissue.
PET Scan (a) and Octreotride labelled (b) scan showing tumor limited to the hepatobiliary system.
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fig7
Follow up MRCP at 1 year showing absence of any filling defect in the left hepatic duct.
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fig8
A follow up MRI (Figure 8) upper abdomen with MRCP at 1 year showed the absence of filling defect in the Left hepatic duct that was seen previously which showed tumor regression.