PMC5831736_01
Case one timeline
12907_2018_70_Fig1_HTML.jpg
PMC5831736_01_12907_2018_70_Fig1_HTML.jpg
Fig1
A 61-year-old retired Chinese male was admitted into our hospital in February 2016, presenting with upper abdominal pain for over 1 month (Fig. 1). The patient died six days after re-admission (61 days after first admission; Fig. 1). The probable cause of death was multiple organ dysfunction syndrome.
Transverse DCE-MRI of the abdomen shows lesions (arrows) in the right lobe of liver. A large mass in the right hepatic lobe is indicated by heterogeneous areas of high signal intensity (arrow) in (a) the T2-weighted image, and heterogeneous areas of low intensity signal (arrow) in (b) the T1-weighted image
12907_2018_70_Fig2_HTML.jpg
PMC5831736_02_12907_2018_70_Fig2_HTML.jpg
Fig2
However, pathological examination confirmed a diagnosis of NEC (Fig. 8 and Additional file 2: Figure S2).
Coronal DCE-MRI of the abdomen shows liver lesions alongside normal bile ducts. a Localized lesions were prominent in the liver capsule, and the right diaphragmatic muscle was raised (arrow). b No dilation of the intrahepatic or extrahepatic bile ducts was observed (arrow)
12907_2018_70_Fig3_HTML.jpg
PMC5831736_01_12907_2018_70_Fig3_HTML.jpg
Fig3
DCE-MRI of the upper abdomen revealed a large mass (17 x 14 x 14 cm) in the right lobe of the liver, as indicated by a region of mixed signal intensity (Figs. 2, 3, 4).
Transverse DCE-MRI of the abdomen shows a large lesion in the right lobe of the liver in four different phases. DCE-MRI showed heterogeneity of signal enhancement in the arterial phase (a), a more obvious heterogeneous signal enhancement in the venous phase (b), slightly weakened heterogeneous enhancement in the equilibrium phase (c), and a significantly weakened heterogeneous enhancement in the delayed phase (d)
12907_2018_70_Fig4_HTML.jpg
PMC5831736_01_12907_2018_70_Fig4_HTML.jpg
Fig4
DCE-MRI of the upper abdomen revealed a large mass (17 x 14 x 14 cm) in the right lobe of the liver, as indicated by a region of mixed signal intensity (Figs. 2, 3, 4). DCE-MRI showed an enhanced intensity in the arterial phase, and a rapid decrease in the intensity of enhancement in the hepatic parenchymal phase, which supported a diagnosis of liver cancer (Fig. 4).
Microscopic finding of a carcinoma of neuroendocrine cells in the liver biopsy from case one. Tumor cells exhibit invasive growth with non-distinct cell borders, light-staining or basophilic cytoplasm, large and dark nuclei with an irregular shape, visible pathologic mitosis, and coagulative necrosis. The biopsy section was stained with hematoxylin-eosin and imaged at 400x. The image was adjusted in Photoshop to remove the pink background and increase the contrast, and the original image before adjustment is provided in Additional file 1: Figure S1
12907_2018_70_Fig5_HTML.jpg
PMC5831736_01_12907_2018_70_Fig5_HTML.jpg
Fig5
PMC5831736_02
Transverse DCE-MRI of the abdomen shows lesions (arrows) in the right lobe of liver. A large mass in the right hepatic lobe is indicated by heterogeneous areas of high signal intensity (arrow) in (a) the T2-weighted image, and heterogeneous areas of low intensity signal (arrow) in (b) the T1-weighted image
12907_2018_70_Fig2_HTML.jpg
PMC5831736_02_12907_2018_70_Fig2_HTML.jpg
Fig2
However, pathological examination confirmed a diagnosis of NEC (Fig. 8 and Additional file 2: Figure S2).
Case two timeline
12907_2018_70_Fig6_HTML.jpg
PMC5831736_02_12907_2018_70_Fig6_HTML.jpg
Fig6
A 69-year-old retired Chinese male was admitted into our hospital in September 2015, presenting with upper abdominal pain for the previous month and dark urine for the previous 2 days (Fig. 6). The patient died 109 days after first admission (Fig. 6).
Enhanced-CT shows multiple lesions in the right and left hepatic lobes in different phases. The right hepatic lobe showed multiple patchy shadows (the largest 94 x 151 mm) and a circular enhanced lesion (arrow) in the (a) arterial and (b) venous phases. The left hepatic lobe showed a patchy shadow within the left lobe of liver (arrow) in (c) the venous phase. The portal triad showed an oval shadow (22 x 38 mm) with soft tissue density (arrow) in (d) the arterial phase
12907_2018_70_Fig7_HTML.jpg
PMC5831736_02_12907_2018_70_Fig7_HTML.jpg
Fig7
Enhanced-CT revealed multiple lesions in the right and left hepatic lobes, and invasion of the lymph node in the portal triad (Fig. 7). Multiple masses were evident in the right hepatic lobe (Fig. 7a, b), a small and patchy shadow was evident in the left hepatic lobe (Fig. 7c), and an oval shadow (22 x 38 mm) was evident in the portal triad, indicating abnormal soft tissue density (Fig. 7d).
Microscopic finding of a carcinoma of neuroendocrine cells in the liver biopsy from case two. Tumor cells are clustered and composed of small cells with little cytoplasm, a high nucleo-cytoplasmic ratio, and dark nuclei with an irregular shape. The biopsy section was stained with hematoxylin-eosin and imaged at 400x. The image was adjusted in Photoshop to remove the pink background and increase the contrast, and the original image before adjustment is provided in Additional file 2: Figure S2
12907_2018_70_Fig8_HTML.jpg
PMC5831736_02_12907_2018_70_Fig8_HTML.jpg
Fig8
However, pathological examination confirmed a diagnosis of NEC (Fig. 8 and Additional file 2: Figure S2).