PMC9632955_01
Results of CT conducted on 3 May 2019. (A) Upper abdominal CT depicting a low-density shadow in the right lobe of the liver. (B) Enhanced CT showing uneven enhancement of the shadow in the right lobe of the liver at the artery stage. (C) Enhanced CT indicating fast enhancement regression of the shadow in the right lobe of the liver at the vein stage. (D) Enhanced CT depicting tumor thrombus formation in the portal vein.
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F1
Upper abdominal computed tomography (CT) revealed a giant mass with dimensions of approximately 6.2 x 5.5 cm in the right lobe of the liver (Figure 1A). The enhanced scan exhibited the characteristics of fast-in and fast-out enhancement (Figures 1B,C). HCC was therefore considered, and tumor thrombus formation was noted in the portal vein (Figure 1D).
Results of CT conducted on 23 July 2019. (A) Upper abdominal CT showing a low-density shadow in the right lobe of the liver. (B) Enhanced CT showing no enhancement of the shadow in the right lobe of the liver at the artery stage. (C) Enhanced CT indicating no enhancement in the shadow in the right lobe of the liver at the vein stage. (D) Enhanced CT depicting portal vein tumor thrombus regression at the vein stage.
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F2
In upper abdominal CT, the mass lesion in the right lobe of the liver was not enhanced in either the artery stage or the vein stage; thus, the low-density shadow without enhancement at both the artery stage and the vein stage at the primary tumor location was considered to be a liquefied necrotic zone after spontaneous tumor regression (Figures 2A-C). The portal vein tumor thrombus had significantly diminished (Figure 2D).
Results of MRI conducted on 11 January 2021. (A) Coronal MRI depicting a low-signal nodule in the left lobe of the liver. (B) Enhanced MRI depicting a high-signal nodule in the left lobe of the liver at the artery stage. (C) Enhanced MRI indicating fast enhancement regression of the nodule in the left lobe of the liver at the vein stage.
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F3
On 11 January 2021, upper abdominal magnetic resonance imaging (MRI) depicted no obvious space-occupying lesion at the former location of the primary tumor but a new space-occupying lesion in the left lateral lobe of the liver (Figure 3A). The enhanced scan exhibited the characteristics of fast-in and fast-out enhancement (Figures 3B,C).
Intraoperative and postoperative examination results. (A) Intraoperative ultrasound depicting a complete regression of the original tumor. (B) Intraoperative ultrasound depicting a new tumor in the left lobe of the liver. (C) Gross postoperative gray-yellow solid nodule specimen. (D) Pathological examination showing a moderately differentiated hepatocellular carcinoma. (E) Pathological examination showing microvascular invasion in the tumor.
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F4
Postoperative gross specimen analysis revealed a gray-yellow solid nodule approximately 2.5 x 1.7 x 1.2 cm in size in the left medial lobe of the liver (Figure 4C), and pathological examination indicated moderately differentiated HCC with microvascular invasion (Figures 4D,E).