PMC2990241_01
The Duplex scanning showed hepatomegaly (18 cm of longitudinal diameter) with presence of heterogeneous mass in the right lobe.
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The mass was hyperechoic with some calcifications and few anechoic foci, secondary to haemorrhage and necrotic processes (Figure 1).
Computed Tomography (CT): axial arterial phase (a); coronal venous phase (c); MIP axial and coronal (b-d). The CT confirmed a mass with heterogeneous density that occupied almost the whole right lobe of the liver (a-c). MIP images showed compressive effects of the mass on sovrahepatic veins; the vessels, were displaced but not infiltrated (b-d).
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Contrast enhancement was low and heterogeneous (Figure 2).
Magnetic Resonance Imaging (MRI): axial T2-weighted images (a); axial T2-SPAIR weighted image (b); axial and coronal THRIVE (c-e); coronal balanced (f); T2-weighted images demonstrated a 23 x 14 x 13 cm heterogeneous mass in the right lobe (a-b). THRIVE images showed heterogeneous contrast enhanced with enhancement of fibrosis bands in tardive-phase (c-e). This heterogeneous mass occupied almost the whole right lobe of the liver presenting a well-defined capsule (f).
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Furthermore right kidney was displaced posteriorly by the mass with its vascular pedicle (Figure 3).
Microscopic examination of mass was composed by a combination of mesenchymal and epithelial elements. The surgical diagnosis confirmed the mixed hepatoblastoma.
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Histopathologic examination revealed the presence of mesenchymal and epithelial cells in bioptic specimen and confirmed the diagnosis of a mixed hepatoblastoma (Figure 4).