PMC9532262_01
The radiological manifestations of liver nodules during the disease process. (A-C) MR images (T2-weighted) showed several round-like hyperintense nodules (white arrows) in the right lobe of the liver. (D-F) PET-CT displayed multiple lesions with increased uptake of nuclear species in the liver. (G-I) MR images (T2-weighted) showed the size of the nodules (white arrows) in the liver was smaller than before after 2 months of antifungal treatment. (J-L) MR images (T2-weighted) showed the liver nodules (white arrows) almost disappeared after 6 months of treatment.
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T2-weighted image (Figure 1A-C) and diffusion-weighted image (DWI, b value = 800 mm/s2) (not shown) showed several hyperintense round-like lesions. The diameter of the largest nodule is approximately 20mm (Figure 1C). Contrast-enhanced MR showed no enhancement of nodules in the arterial phase (see Supplementary Figure 1A-C), while the nodules were slightly hypointense to normal liver parenchyma with peripheral ring-like slight hyperintense area in the portal venous phase (see Supplementary Figure 1D-F) and with peripheral ring-like obvious hyperintense area in the delayed phase (see Supplementary Figure 1G-I). Contrast-enhanced ultrasound of the liver revealed multiple hypoechoic lesions with blurry margins and a little blood-flow signal, while it depicted the arterial-phase enhancement of lesions, stronger than the surrounding liver (wash-in), and hypoechoic intensity compared to the surrounding liver (wash-out) in the venous phase after intravenous administration of ultrasound contrast agent (SonoVue 2mL). 18-fluorine fluorodeoxyglucose positron emission tomography-computed tomography (18-FDG PET-CT) displayed multiple low-dense lesions of various sizes with obviously increased uptake of nuclear species, which indicated the metastatic liver malignancy could not be excluded. (Figure 1D-F). After 2 months of treatment, the size of the nodules in the liver examined by MR significantly decreased compared to that of baseline, and the diameter of the biggest nodule was approximately 7mm (Figure 1G-I). After 6 months of treatment, the liver nodules examined by MR almost disappeared (Figure 1J-L), and the serum CA19-9 and Limulus test levels regressed to the normal range.
The histopathology of the liver specimen obtained from the biggest nodule. The black arrows indicated the granulomatous inflammation with central caseous necrosis. (A) Hematoxylin & eosin staining, (B) Masson triple staining, (C) acid-fast staining, and (D) Hematoxylin & eosin staining of the para-nodule liver specimen.
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The Hematoxylin and Eosin staining of the specimen obtained from the biggest nodule showed granulomatous inflammation with central caseous necrosis and a few multinucleated giant cells (Figure 2A). Masson triple staining indicated that the necrotic area was surrounded by fiber (Figure 2B). The periodic acid-Schiff (PAS), D-PAS, and acid-fast staining (Figure 2C) were all negative. The specimen of para-nodule was presented with chronic inflammatory changes (Figure 2D).