PMC8248484_01
Case 1: A 52-year-old man presented with upper abdominal pain since 3 months. (A) CT scan showed heterogeneously hypo-dense lesions (red arrow). (B) A large exogenous mass in the S3 segment of the liver was observed with irregular thick-walled areas inside the lesion (red arrow). (C) Contrast-enhanced CT in the arterial phase showed uneven mild to moderate enhancement of the lesion with intratumoral vessels and that the tumor has invaded the anterior abdominal wall (red arrow). (D) CT scan in the portal-vein phase showed gradual filling of the lesion from the edge to the center (red arrow). (E) CT scan in the prolongation phase showed gradual filling of the lesion from the edge to the center (red arrow). (F) Histopathological examination of surgical specimen: the carcinomatous component (cholangiocarcinoma) is interspersed with the sarcomatous component (angiosarcoma).
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F1
For sarcomatous components, angiosarcoma was observed in two patients and malignant fibrous histiocytoma was observed in another one patient Figures 1F, 2D, 3D. All three patients had a single lesion in the liver, and CT scan showed an uneven and low-density zone (Figure 1A). An irregular and exogenous shaped tumor lesion was found to be located in the left lobe of the liver of case 1 (Figure 1B), while a pseudo-envelope with a clear boundary was formed around the tumor lesion in case 2 and case 2 (Figures 2A,B, 3A,B). Uneven and mildly enhanced tumor parenchyma and enriched tortuous tumor vessels were observed in the arterial phase (Figures 1C, 2A, 3A). Isodensity with hepatic parenchyma was observed in the portal vein and lag phase (Figures 1D,E, 2B,C, 3B,C).
Case 2: A 42-year-old man had abdominal pain in the right upper quadrant since 1 month. (A) A round mass in the S5 segment of the liver was observed. CT scan in the arterial phase showed uneven, mild to moderate enhancement (red arrow). (B) CT scan in the portal-vein phase showed gradual filling of the lesion from the edge to the center, with irregular thick-walled sac-variable regions (red arrow). (C) CT scan in the prolongation phase showed gradual filling of the lesion from the edge to the center, with irregular thick-walled sac-variable regions (red arrow). The tumor was surrounded by a pseudocapsule. (D) Histopathological examination of the surgical specimen shows PLCS. The carcinomatous component (cholangiocarcinoma) was interspersed with the sarcomatous component (angiosarcoma).
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F2
For sarcomatous components, angiosarcoma was observed in two patients and malignant fibrous histiocytoma was observed in another one patient Figures 1F, 2D, 3D. An irregular and exogenous shaped tumor lesion was found to be located in the left lobe of the liver of case 1 (Figure 1B), while a pseudo-envelope with a clear boundary was formed around the tumor lesion in case 2 and case 2 (Figures 2A,B, 3A,B). Moreover, all three lesions showed mixed density and irregular thick-walled separation changes in the cystic zone (Figures 1B, 2A-C, 3A-C). According to the results of enhanced CT scan, the tumor margins in lesions from all patients were gradually filled and intensified toward the center (Figures 1C-E, 2A-C, 3A-C). Uneven and mildly enhanced tumor parenchyma and enriched tortuous tumor vessels were observed in the arterial phase (Figures 1C, 2A, 3A). Isodensity with hepatic parenchyma was observed in the portal vein and lag phase (Figures 1D,E, 2B,C, 3B,C).
Case 3: A 63-year-old man presented with pain in the right upper quadrant since 1 month. (A) A round mass in the S5 segment of the liver. CT scan in the arterial phase showed uneven, mild to moderate enhancement of the lesion. Tumor vessels were visible in the tumor. Irregular thick-walled sac-variable regions (red arrows) were seen in the lesion. (B) CT scan in the portal-vein phase showed gradual filling of the lesion from the edge to the center, with irregular thick-walled sac-variable regions (red arrow). (C) CT scan in the prolongation phase showed gradual filling of the lesion from the edge to the center, with irregular thick-walled sac-variable regions (red arrow). The tumor was surrounded by a pseudocapsule. (D) Histopathological examination of surgical specimen showing PLCS. Cancerous tissue (cholangiocarcinoma) was interspersed with sarcomatous tissue (malignant fibrous tissue).
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F3
For sarcomatous components, angiosarcoma was observed in two patients and malignant fibrous histiocytoma was observed in another one patient Figures 1F, 2D, 3D. An irregular and exogenous shaped tumor lesion was found to be located in the left lobe of the liver of case 1 (Figure 1B), while a pseudo-envelope with a clear boundary was formed around the tumor lesion in case 2 and case 2 (Figures 2A,B, 3A,B). Moreover, all three lesions showed mixed density and irregular thick-walled separation changes in the cystic zone (Figures 1B, 2A-C, 3A-C). According to the results of enhanced CT scan, the tumor margins in lesions from all patients were gradually filled and intensified toward the center (Figures 1C-E, 2A-C, 3A-C). Uneven and mildly enhanced tumor parenchyma and enriched tortuous tumor vessels were observed in the arterial phase (Figures 1C, 2A, 3A). Isodensity with hepatic parenchyma was observed in the portal vein and lag phase (Figures 1D,E, 2B,C, 3B,C).