PMC6313065_01
Preoperative abdominal CT of the liver tumor. (A) CT demonstrated a low-density mass, measuring 50 mm in the largest diameter, in segment 2 of the liver. (B) The tumor exhibited slight enhancement during the arterial phase and persistent enhancement during the (C) portal and (D) equilibrium phases. CT, computed tomography.
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Computed tomography (CT) demonstrated non-homogeneous enhancement in the arterial phase, persistent enhancement in the portal and equilibrium phases (Fig. 1A-D), and swelling and enhancement of the para-aortic lymph nodes.
Gd-EOB-DTPA-enhanced MRI of the liver tumor. (A) Gd-EOB-DTPA-enhanced MRI demonstrated mild heterogeneous internal enhancement in the early phase; (B) whereas, certain regions exhibited washout in the delayed phase. Gd-EOB-DTPA-enhanced MRI, gadolinium-ethoxybenzyl diethylenetriamine-pentaacetic acid-enhanced magnetic resonance imaging.
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Gadolinium-ethoxybenzyl diethylenetriamine-pentaacetic acid-enhanced magnetic resonance imaging revealed low signal intensity in the hepatobiliary phase (Fig. 2A and B).
FDG-PET of the liver tumor. FDG-PET demonstrated FDG-avid lesions in the left hepatic lobe in the (A) axial plane and para-aortic lymph nodes in the (B) axial plane and the (C) coronal plane. No other notable FDG deposits were determined. Arrow, tumor; arrowhead, swollen para-aortic lymph nodes; FDG, fludeoxyglucose; PET, positron emission tomography.
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Positron emission tomography/CT indicated fludeoxyglucose uptake by the liver tumor and lymph nodes (Fig. 3A-C).
Histopathological analysis of the liver tumor obtained during the needle biopsy. (A) Hematoxylin-eosin staining of the microscopic specimen demonstrated that the tumor cells had slightly eosinophilic cytoplasm and round nuclei with clear nucleoli. Immunohistochemical staining of (B) CK7, (C) EMA, (D) CD56, (E) AFP (F) and glypican 3 demonstrated that the tumor cells were diffusely positive for CK7, positive for EMA (in the luminal membranes), and negative for CD56, AFP and glypican 3 (magnification, x20). CD56, cluster of differentiation; CK, cytokeratin; AFP, alpha-fetoprotein; EMA, epithelial membrane antigen.
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An immunohistochemical examination was performed, according to the manufacturers' protocols; the results indicated that the tumor cells were positive for CK7 and glypican 3, partially positive for CD56 and negative for CK20, AFP, and hepatocyte-specific antigen (Fig. 4A-E). EMA staining revealed positivity in the luminal membranes of the tumor cells (Fig. 4F).
Macroscopic findings of resected liver tumor. (A) The axial cut surface of the resected specimen revealed a well-circumscribed whitish tumor, measuring 46x45x35 mm. Necrosis and bleeding were observed inside the tumor. The tumor exhibited three different histologies, including: (B) Polygonal eosinophilic carcinoma cells arranged in a cord- or nest-like pattern (magnification, x10); (C) spindle-shaped carcinoma cells with an irregular growth pattern; (magnification, x10) and (D) a number of cancer nests with irregular tubular structures (magnification, x20).
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The resected liver tumor measured 46x45x35 mm (Fig. 5A). The tumor was histologically composed of three parts: i) Polygonal eosinophilic carcinoma cells arranged in a cord- or nest-like pattern; ii) spindle-shaped carcinoma cells with an irregular growth pattern; and iii) a number of cancer nests with irregular tubular structures (Fig. 5B-D).
Histopathological analysis of resected liver tumor. (A) Hematoxylin-eosin staining demonstrated tumor cells with enlarged round nuclei and eosinophilic cytoplasm. Immunohistochemical staining of (B) CK7, (C) CK19, (D) EMA, (E) HSA, (F) glypican 3, (G) CD56 and (H) KIT demonstrated that the tumor cells were diffusely positive for CK7 and CK19, positive for EMA (in the luminal membranes), and negative for HSA, CD56 and KIT. HSA, hepatocyte-specific antigen; CD56, cluster of differentiation 56; CK, cytokeratin; EMA, epithelial membrane antigen (magnification, x20).
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This tumor did not exhibit histological features, and had admixtures of small monotonous glands, reflecting so-called antler-like anastomosing patterns as characteristics of CoCC (Fig. 6A). EMA (Fig. 6D), and negative for AFP (Fig. 6E), hepatocyte-specific antigen, glypican 3, CD56 and KIT (Fig. 6F-H). EMA staining indicated that all of the tumor components in the resected specimen were cytoplasmic positive, but the normal liver was negative.