PMC8277514_01
(a) Abdominal ultrasound showing a hypoechoic, mosaic-like, giant mass in the lateral segment of the left hepatic lobe of the cirrhotic liver (arrows). (b), (c) Early arterial phase of a contrast-enhanced computed tomography scan showing an 8 cm hypodense mass in the left hepatic lobe, a hypodense mass with ring-like enhancement in the right lobe, and multiple swollen lymph nodes.
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fig1
With regard to imaging studies, an abdominal ultrasound showed a hypoechoic, mosaic-patterned mass in the lateral segment of the left lobe of the cirrhotic liver (Figure 1(a)). The CT scan also showed moderate ascites and paraaortic and perihepatic lymphadenopathy (Figure 1(b)).
Marked hyperintensity on both the left and right hepatic lobe masses is revealed on diffusion-weighted magnetic resonance imaging (MRI), while peripheral arterial enhancement is seen on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI. (a) T1 in-phase. (b) T1 out-phase. (c) Diffusion-weighted image. (d) Hepatic phase.
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Marked hyperintensity of both the left and right hepatic lobe masses was revealed on diffusion-weighted magnetic resonance imaging (MRI), while peripheral arterial enhancement was seen on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (Figures 2(a)-2(d)).
Fluorodeoxyglucose positron emission tomography scan showing significant accumulation in the left lobe and multiple hot spots in the paraaortic region.
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fig3
A fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed significant accumulation in the left lobe and multiple hot spots in the paraaortic region (Figure 3).
(a) Endoscopic ultrasound view from the gastric station showing no significant amount of ascites. Arrowheads correspond to the surface of an exposed hepatic mass. (b) Endoscopic ultrasound-guided fine-needle aspiration of the liver mass performed from the view without worrisome vasculature or ascites. (c) Histopathological view of squamous cell carcinoma with hematoxylin and eosin staining. Components of neither hepatocellular carcinoma nor adenocarcinoma are found.
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fig4
EUS view from the gastric station showed no significant amount of ascites (Figure 4(a)). EUS-FNA targeting the left lobe mass was performed from the gastric station view without worrisome vasculature or ascites, by using a 22-gauge aspiration needle (EXPECT , Boston Scientific Co., Natick, MA, USA) with 3 passes (Figure 4(b)). Finally, a pathological diagnosis of SCC was made (Figure 4(c)).