PMC9266673_01
A space-occupying lesion of approximately 41x51 mm was found in the right posterior lobe of the liver (indicated by arrows). Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI findings: (A) T1-weighted image, (B) T2-weighted image, (C) ADC map, (D) enhanced image. Contrast-enhanced abdominal ultrasound imaging findings: (E) arterial phase and (F) portal phase.
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T1-weighted images and hyperintense on T2-weighted images (Figure 1A and B). The apparent diffusion coefficient (ADC) map showed that the tumor features restricted diffusion (Figure 1C). After administration of contrast material, the lesion showed hypoenhancing against the background (Figure 1D) and a heterogenic perfusion defect in the hepatobiliary phase. Contrast-enhanced ultrasonography (CEUS) showed hyperenhancement in the arterial phase, and after the contrast agent was rapidly cleared (<40s), the portal and delay phases showed hypoenhancement (Figure 1E and F).
Histologic features of the tumor. (A) The tumor consisted of poorly differentiated cells with major lymphocytic infiltrates (hematoxylin-eosin staining (HE), 200x). Immunohistochemically, the neoplastic cells showed (B) cytokeratin 19 (HE, 200x) and (C) cytokeratin 7 (HE, 200x) expression and (D) no HepPar-1 expression (200x).
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Histologically, the tumor consisted of poorly differentiated tumor cells along with intense lymphocytic infiltrates and interstitial fibrous proliferation (Figure 2A). Immunohistochemically, the neoplastic cells exhibited expression of cytokeratin 19 (Figure 2B) and 7 (Figure 2C) and no expression of HepPar-1 (Figure 2D).
Ultrasound-guided microwave ablation was performed and electrodes were placed inside the tumor (arrow).
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He underwent MWA (Figure 3) without adjuvant therapy and was given anti-HCV medication (400 mg sofosbuvir and 100 mg velpatasvir tablets once per day).
After microwave ablation, MRI showed: (A) T1-weighted image, (B) T2-weighted image, (C) ADC map, (D) enhanced image.
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T2-weighted images, foci measuring 6.0 cm in the right posterior segment of the liver (Figure 4A and B). The ADC map did not show that the lesion features restricted diffusion (Figure 4C). The lesion exhibited mild peripheral enhancement in the arterial phase and low enhancement in venous and delay phases (Figure 4D). The patient has been followed-up with regular outpatient visits and no new lesions have occurred within 9 months after MWA (Figure 5).
Timeline summarizing the main events of this case report.
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The ADC map did not show that the lesion features restricted diffusion (Figure 4C). The lesion exhibited mild peripheral enhancement in the arterial phase and low enhancement in venous and delay phases (Figure 4D). The patient has been followed-up with regular outpatient visits and no new lesions have occurred within 9 months after MWA (Figure 5).