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T2 axial magnetic resonance images of the abdomen, showing enhancing hepatic lesions (white arrows) favoring neoplasm (LI-RADS M: probably or definitely malignant, not necessarily hepatocellular carcinoma).
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Bilirubin rose to 12.8 mg/dL on interval labs and a repeat MRI about a month after the first MRI revealed similar sized lesions with an additional lesion noted (Figure 1).
(A) Liver biopsy specimen showing tumor composed of infiltrative, anastomosing vascular channels lined by atypical pleomorphic cells with hyperchromatic nuclei (hematoxylin and eosin stain, 10x magnification). (B) Liver biopsy specimen showing tumor composed of infiltrative, anastomosing vascular channels lined by atypical pleomorphic cells with hyperchromatic nuclei (hematoxylin and eosin stain, 20x magnification). (C) Tumor sample with ERG immunostain highlighting tumor cells (10x magnification).
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Glypican 3, NKX3.1, and CAMTA1 immunostain were negative (Figure 2A-C).