PMC7229426_01
(A) Axial aspect CT demonstrating a heterogenous lesion (red arrow) exerting mass effect on the surrounding vasculature as well as the stomach, duodenum, and head of the pancreas. (B) Intraoperative photograph of the skeletonized vasculature around the porta hepatis, demonstrating the extent of dissection required for surgical resection of this caudate lobe glomus tumor. As noted, the patient's diaphragm is oriented in the top right corner. Seg 2/3 = segments 2 and 3 of the liver, MHV = middle hepatic vein, LHV = left hepatic vein, RHV = right hepatic vein, IVC = inferior vena cava, PV = main portal vein, LPV = left portal vein. (C) Gross specimen with finger representing main portal vein's course prior to tumor removal. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).
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Imaging revealed a large mass abutting the stomach, duodenum, and head of the pancreas exerting mass effect on the portal vein and inferior vena cava (Fig. 1A). The operation required skeletonization of much of the periportal vascular anatomy and repair of multiple venotomies due to the tumor's adherence to the inferior vena cava (Fig. 1B). Grossly, the resected specimen consisted of a large tan-brown mass measuring 18 cm in greatest dimension and weighing 890 g (Fig. 1C).
Malignant Glomus Tumor of the Liver (Gross and Microscopic Photos) - (A) The liver mass was tan-brown measuring 18 cm in greatest dimension and composed of both a solid and a cystic area. (B) and (C) The tumor cells form a trabecular pattern demonstrated throughout the mass. (D) A higher magnification revealed plump, epithelioid round cells with eosinophilic, smooth cytoplasm and oval, hyperchromatic nuclei. Slits between the trabeculae are lined with thin, endothelial cells. (E) An atypical mitotic figure is surrounded by neoplastic cells displaying prominent nucleoli and atypia. (F) Tumor cells demonstrate the cytoplasmic staining with smooth muscle actin (SMA).
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The cystic portion lacked an epithelial lining and contained bloody fluid with brown-gray coagulated material (Fig. 2A). The slits between the trabeculae were lined with thin endothelial cells (Fig. 2B-D). The tumor cells demonstrated smooth muscle actin (SMA) positivity by immunohistochemistry (Fig. 2F).