PMC5407361_01
Dynamic CT images of the tumor with a prolonged, enhanced pattern in S7 (arrows) in the (A) arterial phase, (B) portal phase, and (C) equivalent phase.
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F1
Dynamic enhanced CT revealed a severe fatty liver and 22-mm tumor with prolonged hyperattenuation in the vascular phases (Figure 1).
Hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI. (A) At initial examination, the tumor showed high intensity at the periphery and low intensity at the center of the tumor. (B) After 6 months, the tumor showed low intensity at the periphery and iso-intensity at the center of the tumor. (C) After 12 months, the tumor showed low intensity at the periphery and center of the tumor.
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F2
Magnetic resonance imaging (MRI) using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) showed uptake in the periphery but not the center of the tumor in the hepatobiliary phase (Figure 2). At 6 months, the tumor extended outward, and the hepatobiliary phase of EOB-MRI showed low intensity at the periphery and iso-intensity at the center, with both showing low intensity 12 months after the initial examination (Figure 2).
(A) Macroscopic finding of dilated blood vessels and interstitial tissue with sclerosis in the center of the tumor, with hyperplastic nodules around it. (B) Hematoxylin and eosin (H&E) staining (10x) showing sclerosed hemangioma (white arrow) and peritumoral hyperplasia (yellow arrow). (C) CD34 staining (40x) showing clerosed hemangioma.
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F3
The lesion contained many dilated, blood-filled vessels, with more abundant stromal tissues with hyalinization around the vessels positive for CD34 (Figure 3).
Premalignant potential of the peritumoral hyperplasia. (A) (H&E) staining (100x). (B) Glutamine synthetase staining (100x). (C) Heat shock protein 70 staining (100x). (D) Clathrin heavy chain staining (100x).
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F4
In part of the PTH-like nodules, glutamine synthetase and heat-shock protein 70 were overexpressed, and clathrin heavy chain was slightly expressed by the PTH-like lesion (Figure 4).