PMC6594277_01
Magnetic resonance imaging (MRI) shows an enlarged liver with central tumor (black arrow), dilated biliary ducts (white arrows), and disseminated metastases (circles) of a pregnant woman at 20 weeks 4 days of gestation. (a) coronal, (b) axial view.
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MRI also displayed mechanical cholestasis with dilated biliary ducts and ascites (Figure 1).
Percutaneous transhepatic biliary drainage (PTBD): consecutive puncture of the right and left biliary ducts, separated by the tumor; catheter in the dilated left biliary ducts (arrow). (a) right (b) left side.
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According to the findings, the patient underwent a percutaneous transhepatic biliary drainage (PTBD) (Figure 2).
The histopathological examination of the liver-biopsy specimens showed a poorly differentiated, diffusely infiltrating signet ring cell carcinoma (SRCC), grade 3. SRCC consists of signet ring cells, containing abundant intracytoplasmic mucin (arrowheads) pushing the nucleus (arrows) to the periphery. Hematoxylin-eosin stain, x40 magnification.
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Pathological examination of the liver-biopsy specimens, obtained at PTBD, revealed a poorly differentiated, diffusely infiltrating SRCC, grade 3 (Figure 3).
Immunohistochemistry revealing tumor cells positive for cytokeratin (CK) 7 (a) and thyroid transcription factor-1 (TTF1) (b). Immunostaining, x40 magnification.
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By immunohistochemistry, the tumor was positive for cytokeratin (CK) 7 (Figure 4(a)). Additional immunohistochemical stains ordered based on sequencing results revealed that the tumor cells were highly positive for thyroid transcription factor-1 (TTF1), which represents a useful marker in the diagnosis of tumors of thyroid or lung origin (Figure 4(b)).
Chest computed tomography (CT) scan demonstrates a mass lesion (5 cm) in the right upper lobe of lung (arrow), and bilateral pleural effusions (arrowheads).
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A chest CT scan demonstrated a large right upper lobe mass (5 cm in diameter), appearing malignant, and bilateral pleural effusions (Figure 5).