PMC6159253_01
(a-f) MRI scan shows a mass occupying the left nasal cavity. (a) Axial T2 weighted MRI scan shows heterogeneous high- signal-intensity mass compared with muscle. (b) Axial T1 weighted MRI scan shows heterogeneous iso-signal-intensity mass and multifocal high-signal foci that suggest a haemorrhagical component. (c). Axial gadolinium-enhanced T1 weighted MRI scan shows heterogeneous enhancement except for multifocal haemorrhagical foci. (d, e) Axial DWI and ADC MRI scan shows that the mass has no diffusion restriction (average ADC value = 1536.01 mm2 s-1). (f). Axial gradient-recalled echo MRI scan shows heterogeneous high-signal-intensity mass and multifocal haemorrhagic foci with dark signal intensity (arrow). ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging.
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Gd-T1 weighted image (Figure 1). Gradient-echo images showed small foci of low signal, suggesting haemorrhage in the mass.
a-c. CT scan shows a mass occupying the left nasal cavity. (a) Axial noncontrast CT scan shows the iso-attenuating mass compared with muscle and no calcification. (b) Axial contrast-enhanced CT scan shows the mass is heterogeneously enhancing. (c) Coronal contrast-enhanced CT scan shows the mass occupying the left nasal cavity. The lateral wall of the maxillary sinus is osteolysed.
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A CT scan that was performed for excisional biopsy (17 days after the MRI scan) showed that the mass had rapidly increased in size (6.2 x 2.2 x 3.4 cm) with involvement of the ostium of the nasolacrimal duct and the lateral wall of the anterior nasal cavity (Figure 2).
Pathological finding of the biopsy specimen from the left nasal cavity mass. Neoplastic polygonal cells are arranged in thick trabecular patterns, consistent with metastasis of hepatocellular carcinoma (hematoxylin and eosin stain; 200x magnification).
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Histological examination revealed tumour cells with enlarged nucleoli and clear cytoplasm arranged in trabecular cords and glandular arrays, consistent with metastatic HCC (Figure 3).