PMC6734173_01
Primary hepatic ACC focal to segments 2 and 3. T1-weighted images shown as A, while T2-weighted images shown in B. The mass shows mild hypointensity, mild T2-weighted hyperintensity and restricted diffusion. Within it, a central stellate area of T1-weighted hypointensity and T2-weighted hyperintensity is visible. The internal central "scar" does not enhance. Within the mass, some radiating enhancing septae are visible. There is no fat nor lipid hyperexpression within the mass. The mass does exhibit mild diffuse enhancement in hepatic arterial phase (A - pre contrast; C - 0.5 min post contrast; D - 1 min post contrast) with slight portal venous phase washout and, on delayed imaging, a capsule (E - 5 min post contrast).
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AFP and CEA were negative. A large, smooth, focal and well-circumscribed 7.7 x 11.1 x 10.4 cm mass (AP x transverse x cephalocaudal maximal dimensions) with septations and an internal central scar was visualized on gadolinium-enhanced MRI of the patient's liver (Fig. 1).
Positron emission tomography (PET) scan status 10 months post left hepatic lobectomy. No evidence of FDG avid local or distant metastatic disease was apparent.
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No local-regional or distant disease was identified on positron emission tomography (PET) scanning 3 and 10 months post-operatively (Fig. 2).
Diastase-digested periodic acid-Schiff (PAS) stain shows intracellular PAS-positive granules consistent with secretory granules. Focally, microacinar structures (white asterisks) are visible. Original magnification x400.
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Cells had fine granular eosinophilic cytoplasm, pale ovoid nuclei with nuclear grooves, and infrequent mitoses (Fig. 3).
Tumour with anastomosing acinar and trabecular growth pattern. Hematoxylin-eosin, original magnification x200.
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Anastomosing acinar and trabeculated growth patterns were also observed (Fig. 4).
Electron micrograph showing intracytoplasmic microvilli as well as intracytoplasmic membrane-bound vesicles (asterisk) consistent with secretory zymogen granules. Direct magnification x2500.
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Occasional cells also demonstrated intracytoplasmic microvilli which indicated epithelial specialization (Fig. 5).