PMC3364086_01
CT of the tumor with (a, b) and without (c) iodine injection, in transversal (a, b) and coronal planes (c). The white arrows (a) indicate an infiltration of the umbilical fissure by the tumor.
cro-0005-0187-g01.jpg
PMC3364086_01_cro-0005-0187-g01.jpg
F1
A CT scan showed a solid and inhomogeneous mass measuring 182 x 66 mm, located under the abdominal wall, causing displacement of the left and right hepatic lobes but distinct from them (fig. 1a-c). Iodine injection showed heterogeneous contrast uptake, with a fat interface between the tumor and intra- and retroperitoneal elements (fig. 1a, b).
MRI of the tumor. a T2-weighted sequences. b T1-weighted sequences with gadolinium injection. c Diffusion sequences.
cro-0005-0187-g02.jpg
PMC3364086_01_cro-0005-0187-g02.jpg
F2
MRI was performed: on T2-weighted sequences, the tumor had a higher signal than the muscle (fig. 2a); gadolinium injection was associated with gradual and heterogeneous contrast enhancement on T1-weighted sequences, evoking fibrosis (fig. 2b), but diffusion MRI showed important cellularity that was highly suspicious for a malignant process (fig. 2c).
Intraoperative findings and histological aspects. a, b Intraoperative findings: the tumor is appended to the round ligament of the liver (white arrows) and free from any other intra-abdominal contact. c, d Macroscopic aspect on cut section after formalin fixation. Firm, gray-white tumor appended to the round ligament (orange arrows). e, f Microscopic aspect and IHC. In e, nonatypical small spindle cells scattered in a fibrous stroma (H&E staining, original magnification x 200). In f, tumor cells strongly express CD34. A large ramified vessel can be seen (orange star is in the lumen of the vessel; original magnification x 200).
cro-0005-0187-g03.jpg
PMC3364086_01_cro-0005-0187-g03.jpg
F3
Laparotomy found a huge and well-limited tumor that, unexpectedly, was appended to the round ligament of the liver (fig. 3a, b) with a 'caput medusae' vascularization. After formalin fixation, it showed a fleshy appearance with gray-white color on cut section and was centered on and appended to the round ligament (fig. 3c, d). Unlike the microbiopsy, the histological examination of the surgical specimen showed many more characteristic areas of small nonatypical spindle cells scattered in a fibrous stroma without any clear architecture (fig. 3e). IHC analysis confirmed strong expression of CD34 by tumor cells and, above all, highlighted very characteristic ramified vessels, so-called 'staghorn' vessels (fig. 3f).