PMC10134145_01
Transverse ultrasound image of the liver demonstrating heterogeneous lesions as indicated by the arrows.
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No portal hypertension, free fluid, or other lesions were identified (Figure 1).
((a) Arterial phase and (b) venous phase): enhanced computed tomography of the abdomen. Selected images of the abdomen demonstrating multifocal parenchymal (thick arrows), subcapsular (thin arrows) lesions and necrosis (arrow head) enhance during the late arterial phase (image (a)) and hypoattenuating in the portal venous phase (image (b)). These are in keeping with a multifocal HCC.
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Considerations included a multifocal HCC or primary hepatic lymphoma (Figure 2(a) and (b)).
(a)-(f): liver biopsy demonstrating hepatocellular carcinoma and hepatitis B virus infection. (a) Haematoxylin and eosin section show trabeculae and nests of hepatocytes invested by endothelial cells (400x). The neoplastic cells are positive for Glypican-3 (b), and capillarization of sinusoids is confirmed by CD34 (c) (400/). (d): H&E section shows resident liver tissue with hepatocytes displaying eosinophilic cytoplasm and nuclear twinning (400x). (e): H&E section shows portal tract expanded by fibrous tissue and scattered inflammatory cells (200x). (f): Immunoperoxidase stain hepatitis B core antigen nuclear staining (200x).
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Histology confirmed hepatocellular carcinoma (Figure 3(a)-(c)). In addition, the hepatitis B core antigen immunoperoxidase stain was positive in the adjacent liver tissue, which was consistent with active hepatitis B virus infection (Figure 3(d)-(f)).