PMC3292925_01
Enhanced CT scan showed a ruptured irregular liver mass. Enhanced CT scan showed a ruptured irregular liver mass (balck arrow) with prominent enhancement at the liver surface inducing contrast leakage into the right subphrenic space.
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F1
Abdomen computer tomography(CT) was thereafter arranged for this patient with contrast injection, which indicated a 3 cm hypervascular mass over segment 5 of liver with active bleeding (Figure 1).
The celiac trunk angiogram showed a hypervascular mass in right lobe of liver with contrast extravastion from the tumor surface (black arrow), which was compatible with CT findings of a hypervascular hepatic tumor bleeding. Figure 2B-After embolization, no contrast extravastion from the tumor was shown.
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F2
Extravastion of contrast medium from the tumor surface was shown which indicated an active tumor bleeding (Figure 2A). Post-embolization angiogram showed that no extravastion of the contrast medium from the right lobe tumor (Figure 2B).
The section of resected liver showed a tumor composed of anastomosing vascular channels in an infiltrating growth pattern. The section of resected liver showed a tumor composed of anastomosing vascular channels in an infiltrating growth pattern. The vascular channels are lined by atypical endothelial cells with enlarged hyperchromatic nucle (black arrow).
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F3
The vascular channels were lined by atypical endothelial cells with enlarged hyperchromatic nuclei (Figure 3).
The section of resected liver showed spindled tumor cells forming hemorrhagic nests and sheets. The section of resected liver showed spindled tumor cells forming hemorrhagic nests and sheets. Rudimentary vascular channels were noted within the tumor cell nest. The spindled tumor cells showed high grade nuclear atypia with brisk mitotic activity(black arrows).
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F4
The tumor cells possessed high grade nuclear atypia and brisk mitotic activity(Figure 4).
Epithelioid areas. Epithelioid areas made up of large rounded tumor cells with high grade nuclear atypia and brisk mitotic activity were also seen(black arrows).
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F5
Epithelioid areas made up of large rounded tumor cells with high grade nuclear atypia and brisk mitotic activity were also seen (Figure 5).
Immunohistochemical study. Immunohistochemical study showed that the tumor cells expressed vascular antigen CD31 strongly(black arrow, score 3+, clone 1A10, Novocastra).
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F6
Immunohistochemically, the tumor cells expressed usual vascular antigens CD31 and CD34 as well as mesenchymal marker, Vimentin (Figure 6, 7, 8).
Immunohistochemical study. Immunohistochemical study revealed that the tumor cells was strongly positive for vascular antigen CD34 (black arrow, score 3+, clone QBEnd-10, Dako).
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F7
Immunohistochemically, the tumor cells expressed usual vascular antigens CD31 and CD34 as well as mesenchymal marker, Vimentin (Figure 6, 7, 8).
Immunohistochemical study. Immunohistochemical study demonstrated that the tumor cells strongly expressed the mesenchymal marker, Vimentin (black arrow, score 3+, clone V9, Novocastra).
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F8
Immunohistochemically, the tumor cells expressed usual vascular antigens CD31 and CD34 as well as mesenchymal marker, Vimentin (Figure 6, 7, 8).
Immunohistochemical study. Immunohistochemical study revealed negative staining of hepatocyte paraffin antibody (HAS, clone OCH1E5, CellMarque) over tumor cells (black arrow).
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F9
The negative staining of HAS and GPC-3 excludes the possibility of hepatocytic neoplasm(Figure 9, 10).
Immunohistochemical study. Immunohistochemical study showed negative staining of Glypican-3 (GPC-3, clone 1G12, Bio SB) over tumor cells (black arrow).
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F10
The negative staining of HAS and GPC-3 excludes the possibility of hepatocytic neoplasm(Figure 9, 10).