PMC8761856_01
(A) The image exhibited with CT. (B) The image of enhanced CT. (C) Porta hepatis lymph node enlargement by enhanced CT. (D) The image of MRI.
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Furthermore, she was examined in line with the care checklist, as shown in  Supplementary Figure 1 . She was admitted and underwent abdominal computed tomography (CT), which demonstrated a 3.3-4-cm soft tissue mass shadow in the neck of the gallbladder which was significantly enhanced on enhanced scan with an unclear boundary to the duodenum and head of pancreas ( Figures 1A, B  ). Porta hepatis lymph node enlargement was also observed ( Figure 1C ). Magnetic resonance imaging (MRI) also showed gallbladder neck mass ( Figure 1D ).
(A) The mass was shown microscopically (x5). (B) High-grade intraepithelial neoplasia of glands (x100). (C) Hepatoid glands (x100). (D) Porta hepatis lymph node (x10).
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The mass was about 3.8 x 3.5 x 1 cm3 in size on the gallbladder wall ( Figure 2A ). The primary lesions consisted of two components: high-grade intraepithelial neoplasia of glands ( Figure 2B ) and hepatoid glands ( Figure 2C ). The lymph node around the gallbladder had been invaded by the hepatoid tumor cells ( Figure 2D ).
Immunohistochemical staining (x40) of (A) Glypican-3, (B) MUC-1, (C) Hep par-1, (D) AFP, (E) Arginase-1, (F) Sall-4, (G) P53, and (H) Ki-67.
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Immunohistochemical staining shows positiveness of glypican-3 and MUC-1 of high-grade intraepithelial neoplasia of glands, but negativeness or weak positiveness in the hepatoid glands ( Figures 3A, B  ). Hepatocyte paraffin 1 (Hep par-1) showed contrasting results ( Figure 3C ). AFP, arginase-1, and Sall-4 were all negative ( Figures 3D-F ), and P53 was strongly positive ( Figure 3G ). The Ki-67 index in hepatoid glands was much stronger than that of other areas ( Figure 3H ).