PMC5899877_01
Ultrasonography (US) images. US showed an isoechoic nodule with small hypoechoic areas in segment 8 of the liver.
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fig1
US showed an isoechoic nodule of 30 x 35 mm with hypoechoic areas in segment 8 of the liver (Figure 1).
Images of contrast abdominal computed tomography (CT). CT showed that the tumor was slowly enhanced from the early phase to the parallel phase. (a) Early phase. (b) Delayed phase. (c) Parallel phase.
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CT showed a tumor that was slowly enhanced from the early phase to the parallel phase (Figure 2).
(a) T1-weighted magnetic resonance (MR) images showed the tumor with low intensity with lobulated borders. (b) The T2-weighted MR image shows the low signal portion indicating the cyst wall or bulkhead inside the high signal region. (c) In the hepatobiliary phase, the tumor showed low intensity. (d) On diffusion-weighted images, markedly high intensity was noted.
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Diffusion-weighted imaging revealed markedly high intensity (Figure 3).
Resected specimen. The mass measured 35 x 50 mm and was located on the hepatic capsule.
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Tumor cleft was a mass with cystic structure in solid part (Swiss cheese-like); there was no necrosis inside (Figure 4).
(a) The tumor comprised tubulocystic structured lesions (H&E). (b) Tumor cells have cell mutation with large nucleoli and eosinophilic cytoplasm, cubic and flat, forming small glands.
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fig5
The tumor cells had large nucleoli and eosinophilic or amphotropic cytoplasm with mildly cellular variety, showing a cuboidal to flattened shape lining the tubules and microcysts (Figure 5).
(a) CD10 positivity in the tumor cells. (b) CAM5.2 positivity in the tumor cells. (c) Vimentin positivity in the tumor cells. (d) CK7 being occasionally positive.
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Immunohistochemically, these atypical epithelial cells were positive for CD10, cellular adhesion molecule (CAM) 5.2 (low-molecular cytokeratin), and vimentin, suggesting a biliary epithelial nature, and were occasionally positive for cytokeratin (CK) 7 (Figure 6).
(a) AE1AE3 negativity in the tumor. (b) CD20 negativity in the tumor. (c) Hepatocyte negativity in the tumor. (d) p53 positivity in the tumor.
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fig7
However, cytokeratin (clone: AE1AE3), beta-catenin, progesterone receptor (PgR), thyroid transcription factor- (TTF-) 1, synaptophysin, thyroglobulin, surfactant apoprotein (SPA), epithelial-CMA (EpCAM), MUC5AC (a mucinous-associated protein), neural cell-CAM (NCAM), human melanin black (HMB) 45, and CD20 were negative (Figures 7(a) and 7(b)). On staining of hepatocytes (Figure 7(c)), alpha-fetoprotein (AFP), glypican-3, and arginase-1 were negative. In the tumor region, these carcinoma cells were specifically positive for p53 (Figure 7(d)).