A 71-year-old man with hepatitis B virus hepatopathy of evolution and refractory to treatment is due to moderate asthenia, acholia and mucocutaneous jaundice.
Analyses reveal an alteration of the entire liver profile.
Abdominal ultrasound and CT scan showed a heterogeneous intrahepatic mass in the left lobe (segments IVa-b) with peripheral enhancement in the arterial phase and hypodense center due to probable necrosis, of approximately 5 cm in the left bile duct.
The rest of the parenchyma presents this anomaly and two simple cysts in the right lobe.
Once diagnosed as probable hepatopathy, segmentectomy IVb is performed with resection of extrahepatic biliary tract and both main hepatic ducts due to tumoral infiltrative carcinoma.
Tumor thrombectomy of the left portal vein was also performed.
The surgery was completed by cholangioyelocalyceostomy on 4 canals.
The patient is discharged after overcoming a hydropic condition.
The Pathological Anatomy Service received a segmentectomy IVb of 9 x 6 cm and 210 g of weight.
At the cut, a confluent multinodular tumor is observed, massively rebleeding, bleaching, measuring 6 x 5 x 9 cm and close to the deep surgical plane.
The tumor and parenchyma distant from it are widely sampled.
Histologically, one of the tumors consists of an epithelial component identified as well differentiated trabecular hepatocarcinoma, with abundant polygonal cells with large eosinophilic cytoplasm and pleoplasma cytoplasm nuclei, and clear neoplasia.
These carcinomatous cells are immunostaining for common hepatocyte antigen and keratin 7, but are immunonegative for cytokeratin 20, anti-cancer agents and alpha-fetoprotein.
The rest of the tumor presents a pleomorph-fusocellular, round, sarcomatous type, with abundant fusiform and chromatin spindle nucleus elongated cells and few pleomorphic cells.
Sarcomatose antigen-100 cells are immunostaining for glimentin, CD10, alpha-1-antitrypsin, actin, CD68 and epithelial membrane antigen (EMA) (the latter three focally markers), and
The two components of the tumor (epithelial and mesenchymal) appear juxtaposed, but not intermixed.
The neoplasm also presents vascular invasion and extensive necrosis.
The non-tumoral parenchyma shows chronic hepatitis with mild fibrosis.
Four months after surgery, the patient developed left portal vein tumor thrombosis, liver failure with ascites, peripheral edema and progressive sepsis leading to death.
