PMC6240724_01
(A) Doppler ultrasonogram showing hyperechogenic, cystic, and hypervascular hepatic perivascular epithelioid cell tumor. (B) Computed tomography scan of tumor.
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On ultrasonography there was a hypoechoic, solid mass with sharp contours and heterogenous pattern which had a size of 16 x 10 cm and diffuse cystic-degenerative areas and which appears hypervascular on Doppler USG (Fig. 1A). A giant hepatic adenoma was primarily considered in the differential diagnosis, which also included liver tumors of mesenchymal origin or hepatocellular carcinoma on a non-cirrhotic basis (Fig. 1B).
(A) Intraoperative view of tumor mass. (B) View of surgical margin. (C) Size of tumor mass. (D) Postoperative cross-sectional area of the liver.
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There was no additional lesion in the abdominal cavity (Fig. 2).
(A) Tumor areas infiltrating the hepatic parenchyma (shown with yellow arrow). (B) Perivascular epithelioid cells with round to ovoid nuclei and abundant eosinophilic cytoplasm, which are occasionally spindle-shaped but mostly epithelioid (shown with yellow arrow). (C) Diffuse positive immunohistochemical staining in cytoplasmic area for HMB-45. (D) Diffuse positive immunohistochemical staining in cytoplasmic area for smooth muscle actin.
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Sections prepared from the tumor showed that it was separated from the adjacent hepatic parenchyma with a clear border but showed infiltration of the parenchyma in a few foci (Fig. 3A). The tumor was highly cellular, the components of which were spindle in shape from place to place and epithelioid in most areas, and they had round-ovoid nuclei and abundant eosinophilic cytoplasm (Fig. 3B). There was diffuse cytoplasmic positivity with HMB-45 (Fig. 3C) and SMA (Fig. 3D).
Computed tomographic follow-up image 10 months after surgery.
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She is under follow-up without recurrence 10 months after the surgery (Fig. 4).