PMC3907205_01
Arterial phase abdominal CT scan showing large right hemiliver mass with areas of cystic degeneration. The residual left hemiliver including the middle hepatic vein being shadowed.
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A CT scan of the abdomen revealed a 20 cm x 15 cm mass occupying most of the hemiliver with cystic degeneration and calcification and multiple dilated collaterals related to the mass (Fig. 1).
CT portography and hepatic venography showing the relation of the mass to the portal and hepatic veins.
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The mass was compressing the right portal vein, yet no invasion detected (Fig. 2).
Operative photography of the mass showing dilated veins extending from the mass to the hepatic flexure of the colon.
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The patient underwent laparotomy through a J shaped incision (Fig. 3).
Cut section of the specimen.
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Cut section revealed a well-defined heterogeneous gray-white to brown friable mass 7.5 cm in diameter (Fig. 4).
(A) The tumor was formed predominantly of small to medium-sized monotonous cells arranged in trabecular pattern separated by highly vascular stroma. There was no histological evidence of HCC (100x). (B) Less than 1% of the tumor cells showed granular cytoplasmic staining for Hep-Par-1. The cells showed no histological evidence of HCC differentiation by H&E (100x). (C) Higher magnification of Hep-Par-1 immunostaining. (D) The same cells showed cytoplasmic positive staining for synaptophysin.
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Tumor cells had round to oval punctuate nuclei within conspicuous nucleoli and scanty cytoplasm (Fig. 5A). Immunohistochemically, the tumor cells were strongly positive for synaptophysin (Fig. 5D) and focally positive for chromogranin-A. Interestingly, the tumor cells showed patchy positive coarse granular staining for HerPar-1 in less than 1% of tumor cells (Fig. 5B and C) while Glypican-3staining was negative.