PMC9608032_01
Simple and dynamic contrast-enhanced CT findings.. Simple CT revealed a 3.0-cm x 2.8-cm low-density mass located in the left median lobe of the liver. (a) Dynamic contrast-enhanced CT showed an enhanced mass in the arterial phase. (b) As well as central washout and slight pseudocapsule enhancement in the portal (c) and delayed (d) phases.. CT, computed tomography.
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Simple CT revealed a 3.0-cm x 2.8-cm low-density mass located in the left median lobe of the liver (Figure 1(a)). Dynamic contrast-enhanced CT showed an enhanced mass in the arterial phase (Figure 1(b)), as well as central washout and slight pseudocapsule enhancement in the portal and delayed phases (Figure 1(c) and (d)).
MRI findings using Gd-EOB-DTPA.. The mass exhibited low intensity on T1-weighted images (a) and high intensity on both T2-weighted images (b) and diffusion-weighted images. (c) Slight enhancement was observed in the arterial phase. (d) Contrast medium washout was evident in the portal (e) and liver (f) phases.. Gd-EOB-DTPA, gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid; MRI, magnetic resonance imaging.
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T2-weighted and diffusion-weighted images (Figure 2(b) and (c)); MRI also revealed slight enhancement in the arterial phase (Figure 2(d)) and contrast medium washout in the portal and liver phases (Figure 2(e) and (f)).
Histopathological findings.. Pathological examination showed columnar tumor cells with atypical nuclei that proliferated in a cord-like or glandular tubular pattern. The tumor cells were surrounded by collagen fibers and dense lymphocytic infiltration, as well as lymphoid follicles. (a) HE x100 and (b) HE x400.. HE, hematoxylin and eosin.
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Pathological examination showed columnar tumor cells with atypical nuclei that proliferated in a cord-like or glandular tubular pattern (Figure 3(a)). The tumor cells were surrounded by collagen fibers and dense lymphocytic infiltration, as well as lymphoid follicles (Figure 3(b)).
Immunohistochemical staining and EBER-ISH findings.. Immunohistochemical examination revealed that the findings of HepPar-1 (a, x400) and arginase (b, x400) were negative, indicating non-hepatocyte origin. However, the biliary type cytokeratins CK7 (c, x400) and CK19 (d, x400) were positive. EBER-ISH using a fluorescein-conjugated probe (Bond Ready-to-Use ISH EBER Probe, Leica Biosystems, Melbourne, Australia) according to the instructions was negative, suggesting no latent EBV infection in the tumor. (e) PD-L1 (f, x200) findings were partially positive in tumor cells (20-30%) and negative in immune cells.. EBER-ISH, EBV-encoded RNA in situ hybridization; EBV, Epstein-Barr virus; PD-L1, programmed death-ligand 1.
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Immunohistochemical analysis showed negative HepPar-1 and arginase findings, indicating non-hepatocyte origin (Figure 4(a) and (b)); however, the biliary-type cytokeratins CK7 and CK19 were positive (Figure 4(c) and (d)). Probe, Leica Biosystems, Melbourne, Australia) according to the instructions was negative, suggesting no latent EBV infection in the tumor (Figure 4(e)). Programmed death-ligand 1 (PD-L1) findings were partially positive in tumor cells (20-30%) and negative in immune cells (Figure 4(f)).