PMC7265047_01
Gd-EOB-DTPA-MRI imaging.. Gd-EOB-DTPA-MRI demonstrated multiple metastases (11 metastases) in both liver lobes (arrows).. (a) arterial phase (b) portal phase (c) equilibrium phase (d) hepatobiliary phase
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Contrast-enhanced CT and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) revealed multiple metastases in both lobes of the liver (Fig. 1a-d).
Diagram and operative findings.. a, b) First operation. (a) Diagram showing line of liver resection for the first operation.. (b) Portal vein embolization of the posterior segmental branch (arrows).. c, d) Second operation. (c) Diagram showing line of liver resection for the second operation.. (d) Intraoperative image shows the demarcation line appearing after clamping the right hepatic vein.
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During the first-stage, left lateral segmentectomy, partial hepatectomy of segment 5/8 and portal vein embolization of the posterior segmental branches through the ileocolic vein were performed concomitantly (Fig. 2a,b). The second-stage surgery was therefore performed 21 days after the first surgery, as resection of the right hepatic vein drainage area (i.e., posterior and dorsal section of the anterior segment) (Fig. 2c). The demarcation line was visualized by clamping the common hepatic artery and right hepatic vein (Fig. 2d).
Pathological diagnosis.. Microscopic examination of the resected liver specimen shows proliferation of atypical cells displaying features characteristic of atypical pulmonary carcinoid.. (a) Hematoxylin & eosin staining x200: The tumor comprises trabecular, palisading and rosette-like structures with round nuclei of various sizes and eosinophilic granular cytoplasm.. (b) Immunohistological staining x200: Immunochemistry of atypical carcinoid positive for synaptophysin.. (c) Immunohistological staining x200: Immunochemistry of atypical carcinoid positive for chromogranin A.
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The tumors were finally diagnosed as metastatic AC tumors originating from the lung (Fig. 3a-c).