PMC6389595_01
Abdominal ultrasonography showing (a) a hypoechoic lesion measuring 61 mm in diameter located in the posterior section and (b) a hypoechoic lesion measuring 10 mm in diameter at the root of the right hepatic vein.
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Abdominal ultrasonography showed a low echoic tumor, which was 60 mm in diameter, in the posterior section of the liver and an isoechoic tumor, which was 6 mm in diameter, at the root of the right hepatic vein (RHV; Fig. 1).
Plain and enhanced CT findings. A 61 mm tumor in the posterior section was observed as (a) a low density area in the plain phase, (b) a slightly high density area in the artery phase, (c) a strong high density area in the portal phase, and (d) an isodensity area in venous phase.. A 10 mm tumor at the root of right hepatic vein was observed as (a) a low density area in the plain phase, (b) a high density area in the artery phase, (c) a high density area in the portal phase, and (d) an isodensity area in the venous phase.
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Another small 10-mm tumor at the root of RHV also showed high density in the arterial phase and isodensity in the portal and late phases (Fig. 2).
Gb-EOB-MRI findings. The 61 mm tumor in the posterior section showed high intensity on (a) T2-weighted and (b) pre dynamic images. A high intensity area in the arterial phase was also observed that washed out in 60 s (c) to 180 s (e). In the hepatobiliary phase, a borderline, clear, low intensity lesion is seen (f).. The small 11 mm tumor could not be seen by Gb-EOB-MRI.
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Pathological and immunohistochemistry findings. Regarding the larger tumor, (a) macroscopically, it measured 61 mm and was white in color, (b) microscopically, it had normal hepatocytes with mild sinusoidal dilation, and (c) the hepatocytes were positive for CRP by immunohistochemistry.. The smaller tumor measured 11 mm in diameter with (d) a white area and an unclear margin, (e) normal hepatocytes and lymphocytes, and (f) CRP-positive hepatocytes.
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Immunohistochemistry findings of the larger tumor showed that the hepatocytes were positive for C-reactive protein (CRP) and liver fatty acid-binding protein (LFABP) and negative for beta-catenin, glutamine synthetase (GS), and glypican-3 (Fig. 4).