PMC8451253_01
(a) Non-contrast CT abdomen demonstrating multiple liver lesions with high attenuation. (b) Contrast CT abdomen demonstrating scattered foci with nodular enhancement. (c and d) MRI abdomen showing low T1 and high T2 signal. (e) MRI abdomen showing small area of high T1 signal and restricted diffusion in the right lobe of liver, likely representing haemorrhage.
10.1177_2050313X211046726-fig1.jpg
PMC8451253_01_10.1177_2050313X211046726-fig1.jpg
fig1-2050313X211046726
Multiphase computed tomography (CT) demonstrated multiple liver lesions with high attenuation on the non-contrast study compatible with intra-lesional haemorrhage (Figure 1(a)). There were also scattered foci of nodular enhancement on the arterial phase and low attenuation on the portal venous phase (Figure 1(b)). Subsequent magnetic resonance imaging (MRI) showed no features of cirrhosis; the lesions were of low T1 and high T2 signal and did not show restricted diffusion (Figure 1(c) and (d)), aside from an isolated area in the right lobe which was felt to be related to haemorrhage (Figure 1(e)).
(a) CT abdomen revealing rapid interval growth with haemoperitoneum. (b) PET scan demonstrating a grossly enlarged liver containing innumerable peripheral foci of radiotracer activity with a large photopaenic area in the right lobe, and further separate foci of tracer scattered in the left lobe. There are also innumerable FDG-avid bony deposits. (c) CT pelvis revealing a pathological fracture (arrow). (d) Corresponding PET image demonstrating FDG-avid lesion in the same area.
10.1177_2050313X211046726-fig2.jpg
PMC8451253_01_10.1177_2050313X211046726-fig2.jpg
fig2-2050313X211046726
It was clear that the liver lesions had significantly increased in size over the short time interval (Figure 2(a)). A whole-body positron emission tomography (PET)/CT scan confirmed widespread malignant involvement of the liver and bones (Figure 2(b)-(d)), and a bone biopsy revealed a poorly differentiated large cell cancer of unclear source.
(a) Macroscopic view of the liver at autopsy revealing extensive tumour infiltration. (b) Microscopic view of section of liver at autopsy revealing strongly positive staining to CD34.
10.1177_2050313X211046726-fig3.jpg
PMC8451253_01_10.1177_2050313X211046726-fig3.jpg
fig3-2050313X211046726
At autopsy, there was marked hepatomegaly with extensive replacement of the liver parenchyma by tumour nodules at various stages of haemorrhage, thrombosis and necrosis (Figure 3(a)). Immunohistochemistry demonstrated endothelial differentiation of the tumour cells, with strong and diffuse positivity for CD31, CD34 (Figure 3(b)) and ERG.