PMC8695756_01
On CT plain image, the nodule is slightly low-density lesion in the S4 of the liver (A). On contrast-enhanced CT images, the lesion showed slight enhancement in arterial phase (B) and slight washout in portal phases (C). The white arrow points to the lesion. Malignant tumor could not be excluded.
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HCC was suspected, but no hepatic cirrhosis and history of hepatitis (Figure 1).
Fat-saturated T1-weighted image (A) showed a hypointense lesion measuring 17 mm in the segment 4 of the liver. The lesion showed hyperintensity on T2-weighted image (B). On enhanced T1-weighted images, the lesion showed obvious enhancement in arterial phase (C), and in portal phase (D) the lesion showed slight washout and perinodular enhancement. On DWI (E) and ADC (F) images, the lesion showed a significant diffusion restriction. The white arrow points to the lesion.
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Other lesions in segments 7 and 5 showed the same hemodynamic characteristics as the tumor in segment 4 ( Figure 2).
18FDG PET-CT images. Maximum intensity projection PET (A). Transverse CT (B) showed a slightly low-density lesion in segment 4 of liver. Corresponding PET (C) and fused (D) images showed increased FDG uptake with SUVmax of 4.81. Corresponding PET image (E) after 1.5 h delay showed the FDG uptake that continued to increase with SUVmax of 5.24, and the detention index was 8.9%. However, the lesions in the S7 and S5 of the liver showed no significant increase in FDG uptake.
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However, the lesions in segments 7 and 5 of the liver showed no significant increase in FDG uptake ( Figure 3).
Pathological findings with hematoxylin-eosin (HE) staining showed that there were a large number of reactive proliferative lymphoid follicles in the tumor area, and the germinal center was composed of non-dysmorphic lymphocytes or plasma cells, fibrous collagen, and hyaluronic matrix, and remaining normal bile ducts (red arrows) can be seen along the edge of the lesion (A, HEx100). Lymphoid tissues grow around the small bile ducts (B, HEx200). A uniform red-stained matrix deposit can be seen in the lesion (C, HEx400). The results of immunohistochemistry showed that CD20-positive lymphocytes grew around the small bile ducts (D, IHCx200). CD3 (E, IHCx100), CD10 (F, IHCx40), CD23 (G, IHCx40), Ki-67 (H, IHCx40) staining showed reactive proliferative lymphoid follicles in the lesion.
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EBV negative by qRT-PCR method (Figure 4).