PMC6469470_01
Pathological characteristics demonstrated by H&E staining of the patient (100x).. Notes: A large number of transparent cells with diffuse distribution were observed in the primary liver tumor, lung metastatic lesion, and adrenal metastatic lesion. (A) Histopathology of primary liver tumor in December 3, 2009. (B) Histopathology of lung metastatic lesion in July 20, 2012. (C) Histopathology of adrenal metastatic lesion in October 13, 2017.
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The results of H&E staining are shown in Figure 1A. Based on the pathological characteristics demonstrated by H&E (Figure 1B) and immunohistochemical staining in the lung mass; the positive expression of hepatocytes and CK (Figure 3A); and the negative expression of vimentin, the lung mass was lung metastasis derived from the primary liver tumor. Histopathology showed that the mass was an adrenal metastatic PCCCL based on its pathological characteristics demonstrated by H&E (Figure 1C) and immunohistochemical staining, which exhibited the high expression of hepatocytes and glypican (Figure 3B).
CT images of the patient.. Notes: (A1-A5) Images at the start of sunitinib administration (June 29, 2012). Multiple metastatic lesions in the liver (A2) and other parts of the body, including the retroperitoneal lymph nodes (A3), lung (A1), and bilateral adrenal nodules (A4 and A5), were observed. (B1-B5) Two years after the start of sunitinib administration (May 21, 2014). Marked decrease in the size of all metastatic lesions was observed. (C1-C5) Images at 4.75 years after the start of sunitinib administration (March 2, 2017). All intrahepatic tumors had shrunk, no enhancement of tumor staining was observed in the arterial phase, and the lung metastasis had disappeared.. Abbreviation: CT, computed tomography.
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According to the result of a thorough examination in June 29, 2012, the patient's disease has recurred with multiple metastatic lesions in the liver and other parts of the body, including the retroperitoneal lymph nodes, lung and bilateral adrenal nodules based on the CT scan (Figure 2A). The tumor size steadily reduced, and the lesions were no longer obvious in May 21, 2014 (Figure 2B). The maximum diameter of the right adrenal mass decreased to 1.5 cm in March 2, 2017 (Figure 2C) and slightly increased to 2.1 cm in September 20, 2017.
Immunohistochemical staining of hepatocytes, PDGFR, and VEGFR in the primary tumor and metastatic lesion.. Notes: (A) High expression of hepatocytes in the lung metastatic lesion in July 20, 2012 (200x). (B) High expression of hepatocytes in the adrenal metastatic lesion in October 13, 2017 (100x). (C and E) Negative expression of PDGFR and VEGFR in the primary liver tumor in December 3, 2009 (100x). (D and F) Negative expression of PDGFR and VEGFR in the adrenal metastatic lesion in October 13, 2017 (100x).. Abbreviations: PDGFR, platelet-derived growth factor receptor; VEGFR, vascular endothelial growth factor receptor.
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Based on the pathological characteristics demonstrated by H&E (Figure 1B) and immunohistochemical staining in the lung mass; the positive expression of hepatocytes and CK (Figure 3A); and the negative expression of vimentin, the lung mass was lung metastasis derived from the primary liver tumor. Histopathology showed that the mass was an adrenal metastatic PCCCL based on its pathological characteristics demonstrated by H&E (Figure 1C) and immunohistochemical staining, which exhibited the high expression of hepatocytes and glypican (Figure 3B). We found that PDGFR and VEGFR were not expressed in these tissues (Figure 3C-F).