PMC3700498_01
Computed tomography (CT) of the patient (case 1) revealed narrowing of the inferior vena cava (IVC) and massive ascites (A, B). An early enhanced nodule was seen in S8 (C).
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Two months after radiation, the patient's clinical course continued to deteriorate with worsening ascites and encephalopathy, progressing to renal insufficiency, and CT imaging revealed massive ascites and a high-density nodule in liver segment 8 (Figure 1). This nodule showed enhancement in the arterial and portal phases, suggesting a hyperplastic nodule (Figure 1).
The liver explant showed congestion and swelling. Exclusion of the inferior vena cava (IVC) by the swollen caudate lobe (A) was observed, but not stenosis of the large IVC or hepatic vein (B).
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We observed exclusion of IVC by the swollen caudate lobe, but no stenosis of the large IVC or hepatic vein (Figure 2).
Low-power examination using hematoxylin and eosin staining showed a collapse of hepatocytes around a central vein (A). Low- and high-power examination using Elastica van Gieson stain showed concentric narrowing of the terminal hepatic venules (B, C).
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In the center of these areas, concentric narrowing of the terminal hepatic venules or sublobular hepatic veins caused obstruction of the lumen (Figure 3).
Loupe examination showed nodular lesions (arrow) (A). High-power examination showed slightly increased cell density, but no cellular atypia (B).
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Therefore, this nodule was diagnosed as hyperplastic nodule (Figure 4).
PMC3700498_02
In case 2, microscopic examination of a liver specimen stained with hematoxylin and eosin using a low-power objective showed severe congestion and necrosis around a central vein. High-power examination showed. High-power examination.
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Microscopic examination indicated that the sinusoid was markedly dilated (Figure 5).