PMC4772612_01
Contrast-enhanced CT imaging demonstrating no cirrhotic changes prior to 90Y administration (a) and generalized mottled changes compatible with postembolization edema 3 months after 90Y administration (b). The patient subsequently developed a large, nonenhancing, complex cystic central hepatic lesion suggestive of a post-90Y biloma 14 months after administration (c) and over the subsequent 45 months developed a progressively irregular texture suggestive of hepatic cirrhosis (d).
cro-0009-0076-g01.jpg
PMC4772612_01_cro-0009-0076-g01.jpg
F1
This was initially noted 10 months after 90Y treatment and was slightly progressive on the 14-month scan (fig. 1). Thirty-five months after initiation of everolimus therapy, radiographic note was made of the advanced cirrhotic appearance of the liver (fig. 1) and the increase in size of a left hepatic lesion.
Needle core biopsy of the liver taken 47 months after 90Y administration. a There is a large band of chronically inflamed fibrous tissue, highly suggestive of cirrhosis. HE. x10. b This is highlighted by Masson trichrome staining, demonstrating chronically inflamed fibrous tissue (blue), highly suggestive of cirrhosis. x10. c The nonfibrotic liver showed macrovesicular steatosis with mildly active steatohepatitis. HE. x40. d On the other hand, sinusoidal Kupffer cells showed a mild degree of hemosiderosis. Perls iron stain. x40.
cro-0009-0076-g02.jpg
PMC4772612_01_cro-0009-0076-g02.jpg
F2
The biopsy demonstrated large fibrotic bands in keeping with cirrhosis with mildly active steatohepatitis (approx. 10% macrovesicular steatosis) (fig. 2).