PMC9830012_01
Images and liver biopsy at diagnosis of NPC (at 6 months old, A-C) and HCC (at 6 years old, D-F). (A) Coronal T1-weighted image of MRI, (B) coronal T2-weighted image of MRI, (C) liver biopsy showing hepatitis with lipid-laden macrophages and perisinusoidal fibrosis (hematoxylin and eosin [H&E], x200), (D) abdominal CT scan showing liver cirrhosis with a large hypervascular mass and splenomegaly, (E) chest CT scan showing multiple pulmonary metastases, (F) liver biopsy confirming confirms HCC of Edmondson-Steiner grade 2 ([H&E], x200)
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Abdomen ultrasound and liver MRI showed marked hepatomegaly with multifocal nodularity and splenomegaly (Figure 1A,B). The liver biopsy demonstrated a giant cell transformation with ballooning degeneration, pinkish intracytoplasmic globules, and perisinusoidal fibrosis (Figure 1C). Additional liver dynamic computed tomography (CT) demonstrated cirrhosis and there were multiple malignant hepatic tumors with a large vascularized mass of 10 cm diameter in the right liver (Figure 1D). A chest CT showed multiple lung metastases (Figure 1E). The liver biopsy confirmed the diagnosis of HCC (Figure 1F).
Clinical parameters and images of the patient. (A) Growth chart, (B) laboratory findings including transaminase, INR, and AFP, (C) liver ultrasound images showing cirrhotic liver with nodules at the last visit (upper panel), a large hyperechoic mass newly appeared at diagnosis of HCC (lower panel)
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The clinical course and parameters were described in Table 1 and Figure 2. His height and weight were in the third percentile for age (Figure 2A). Systemic symptoms including cirrhotic liver with elevated transaminases and splenomegaly were stationary for a while (Figure 2B,C upper panel). Leaving a lot to be desired, the alpha-fetoprotein (AFP) level was not checked for the last few years (Figure 2B lower panel). An abdominal ultrasound showed multiple hyperechoic nodules in the liver and splenomegaly (Figure 2C lower panel). AFP level was elevated to 385,202 ng/ml (Figure 2B lower panel).