PMC10051143_01
Abdominal CT - axial sections showing the hepatic lesions (red arrows).
. (A) The lesions are spontaneously hypodense. (B) After injection of contrast product, the lesions are intensely enhancing in the arterial phase. (C) Contrast product wash out in the portal phase.
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F1
The lesions were spontaneously hypodense, intensely enhancing after injection of contrast product in the arterial phase with a wash out in the portal phase (Figure 1).
Hepatic MRI - axial sections.
. (A & B) Hepatic lesions (red arrows) in hypersignal T2 and diffusion respectively. (C) Post-contrast images show enhancement in the arterial phase with a wash out in the portal and late phases.
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F2
The lesions were hyperintense on T2- and diffusion weighted MRI, enhancing in the arterial phase with a wash out in the portal and late phases (Figure 2).
Histological features of the hepatic VIPoma.
. (A) Glandular architecture of the tumor (Hematoxylin-eosin x100). (B) Tumor cells are monotonous and display round nuclei and moderate amounts of eosinophilic cytoplasm. Nuclei show a characteristic stippled ("salt and pepper") chromatin pattern with inconspicuous nucleoli (Hematoxylin-eosin x400). (C) The tumor is diffusely and strongly positive for CD56 immunostaining (x400). (D) The proliferation marker Ki-67 highlights 2% of the neoplastic cells (arrow), consistent with a low proliferation index (x400).
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F3
A and CD56) (Figure 3). Anti-VIP antibodies were not however available.
Hepatic arteriogram with selective catheterization of the right hepatic artery from the femoral artery.
. (A & B) A progressive blush of both lesions (red arrows) following the injection of contrast media. (C) Angiographic control showing total disappearance of the tumoral blush.
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F4
On the first session, the lesions in segment I and III were treated with excellent immediate results (Figure 4).
Follow-up abdominal CT taken one month after the second session of transarterial chemoembolization.
. The CT showed a dense and homogeneous lipiodol deposition in the tumor on precontrast images (red arrow in [A]), without persistent arterial phase hyperenhasement (red arrow in [B]).
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F5
Abdominal CT scan performed after 4 weeks showed complete necrosis of the lesions (Figure 5).