PMC6562361_01
Preoperative images.. a) Positron emission tomography image.. b) Magnetic resonance (MR) T2-weighted image.. c) MR imaging diffusion-weighted image.. Glisson's pedicle infiltration (arrow) was suspected on the basis of these images.
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On PET-CT, the mass presented as a hot, linear-like lesion, that almost appeared as two separate lesions (Fig. 1a). T2- and diffusion-weighted images from gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced (Gd-EOB-DTPA) MR imaging revealed a high-intensity mass with invasion of Glisson's pedicle in segment V of the liver (Fig. 1b/c).
Cut surface of the resected liver.. The straight line indicates the liver surface, the arrow indicates the gallbladder bed, and the dotted line indicates the cut surface.
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On gross appearance, the surgical margin of the tumor was within the cut surface (Fig. 2).
Pathological findings (Hematoxylin-eosin staining).. a)-c) Magnification, x40.. d)-f) Magnification, x200.. The resected tumor was pathologically similar to the primary gastric cancer rather than colon cancer.
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On the basis of the pathological reports of previously resected specimens of gastric and colon cancers, the resected tumor was pathologically similar to gastric cancer (Fig. 3).
Elastica hematoxylin-eosin staining (magnification, x20).. The straight line indicates the interlobular vein, and the arrow head indicates the interlobular artery. The dotted line indicates metastatic infiltration of the interlobular bile duct.
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Tumor infiltration of Glisson's pedicle, including the interlobular bile duct, was also confirmed on pathological analysis (Fig. 4).
Immunohistochemical staining (magnification, x100).. a)-c) CDX-2 levels.. The nuclei of the primary colon cancer cells were diffusely positive, while those of the metastatic and primary gastric cancer cells were negative.. d)-f) CK-7 levels.. The epithelium of the metastatic and primary gastric cancer samples was highly positive, and that of the primary colon cancer sample was weakly positive (judged as negative).. g)-i) CK-20 levels.. The epithelium of the colon cancer sample was diffusely and highly positive, while the epithelium was negative in the metastatic and primary gastric cancer samples.. Immunohistochemical findings of the resected specimen were compatible with those of the primary gastric cancer, but not with those of the colon cancer.. CDX, caudal-type homeobox; CK, cytokeratin.
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Immunohistochemical staining was negative for caudal-type homeobox (CDX)-2 and cytokeratin (CK)-20 and positive for CK-7; these findings were compatible with those of previous gastric cancer rather than colon cancer (Fig. 5).