PMC7656861_01
(a) Coronal view of CECT abdomen showing a 7.3 cm x 5.8 cm x 4.7 cm lesion involving segments II, III and IVa with large central area of necrosis and contiguous extension into greater omentum. (b) Axial view: obliteration of left portal vein (proximal; distal not visualized) and left hepatic vein.
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No retroperitoneal lymphadenopathy was noted (Figure 1(a) and (b)).
(a) Gross slice of liver showing greyish white nodules with focal necrosis. (b) Areas of geographic necrosis in the liver (H&E 40x). (c) Interface region showed histiocytes, foreign body type giant cells (H&E 200x). (d) Giant cells containing multiple fungal profiles (H&E 400x).
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The adjoining liver parenchyma was essentially normal (Figure 2(a)). Microscopically, multiple large areas of geographic necrosis bordered by multiple foreign body giant cell granulomas composed of plump epithelioid cells, histiocytes, eosinophils, and lymphomononuclear cells (Figure 2(b) and (c)). Additionally, many suppurative granulomas were seen within which multiple short and broad pauci-septated hyphae bordered by eosinophilic granular material (Splendore-Hoeppli phenomenon) were noted (Figure 2(d)).
(a and b) Broad pauci-septate fungal hyphae surrounded by eosinophilic granular material (Splendore-Hoeppli phenomenon) (H&E 400x). (c) PAS stain (arrow) highlights the fungal profile (400x). (d) Grocott's stain (arrow) highlights the fungal profile (400x).
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The characteristic obtuse-angle branching of fungal hyphae was highlighted by Periodic acid Schiff (PAS) and Grocott's silver methanamine stains (Figure 3(a)-(d)).