PMC3287964_01
Abdominal CT image demonstrating a large mass lesion in the right hepatic lobe.
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F1
An abdominal CT scan revealed a 4.8 x 4.7 cm mass lesion involving the right hepatic lobe that was suspicious for malignancy (Figure 1).
The right partial hepatectomy shows florid necrotizing granulomatous inflammation for a peudotumorous mass (Figure 2, hematoxylin and eosin 100x). Necrotizing granulomatous inflammation with giant cells and characteristic palisading histiocytes.
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F2
Histopathological studies of the resection specimen showed florid necrotizing granulomatous inflammation with pseudotumor formation (Figure 2, 3).
The right partial hepatectomy shows florid necrotizing granulomatous inflammation for a peudotumorous mass. Necrotizing granulomatous inflammation with giant cells and characteristic palisading histiocytes (Figure 3, hematoxylin and eosin 400x).
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F3
Histopathological studies of the resection specimen showed florid necrotizing granulomatous inflammation with pseudotumor formation (Figure 2, 3).
Repeat abdominal CT after initial hepatic resection. Several new, low-attenuation lesions are present in the right hepatic lobe. Similar, smaller lesions were present in the left hepatic lobe (not shown).
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F4
An abdominal CT revealed several low attenuation lesions involving both segments of the liver, with the largest one measuring 4.1 x 2.9 cm (Figure 4).
PCR results targeting the Bartonella 16S-23S rRNA intergenic spacer region using primers 325-1000 and primers 425-1100 (top row) and Bartonella koehlerae specific primers (bottom row). With primers 325-1000, amplicons were obtained in lanes 1-3 from the resected liver lobe (pre-antibiotic treatment) but not in Lanes 4-5 (post-treatment liver biopsy). With primers 425-1000, single amplicons were obtained in the pre- (Lane 2) and post-treatment (Lane 5) liver samples. By DNA sequencing, all amplicons corresponded to a 16S-23S strain of B. henselae. No amplicons were obtained with the B. koehlerae primer set. RC = DNA extraction control, lane, BH = B. henselae (Houston I strain), PO = PCR negative control, M = Kb DNA ladder.
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F5
Subsequently, using 16S-23S ITS primers, B. henselae DNA (SA2 strain by DNA sequencing) was amplified and sequenced from paraffin blocks containing material from the initial liver resection (January 2009) and from the follow-up biopsy obtained in September of 2010 (Figure 5).