case_images: PMC6076899_01
case_images: The biopsy showed the tumor was composed of epithelioid to spindle cells infiltrating between hepatocytes with markedly atypical nuclei and prominent necrosis, exhibiting a pleomorphic pattern. (a) Hematoxylin and eosin stain at 100x magnification; (b) and (c) hematoxylin and eosin stain at 400x magnification; (d) Epithelial-Panel staining; (e) other linage staining: HMB-45, desmin, and SMA (the rest of staining not shown).
case_images: CRIPA2018-8031253.001.jpg
case_images: PMC6076899_01_CRIPA2018-8031253.001.jpg
case_images: fig1
case_images: The biopsy showed an epithelioid to spindle cell neoplasm infiltrating between hepatocytes with markedly atypical nuclei and prominent necrosis (Figures 1(a), 1(b), and 1(c)). Extensive immunostaining was performed, including hepatocellular carcinoma markers (AFP, HepPar1, Glypican-3, polyclonal CEA, and ARG1), other epithelial antigens (CK7, CK20, AE1/AE3, CAM5.2, EpCAM, and EMA) (Figure 1(d)), Inhibin, CD117, CD30, and CD3, and ALK-monoclonal, germ cell markers (AFP, OCT3/4, and HCG), melanoma markers (Melan-A, S-100, and SOX10), and endothelial (CD31) and muscle (smooth muscle actin) markers (Figure 1(e)) were all negative. The tumor cells were also negative for HMB-45, CD15, CD20, CD21, CD23, CD43, CD45, desmin, myogenin, calretinin, myeloperoxidase, D2-40, CD68, and clusterin (Figure 1(e)).
case_images: Postbiopsy PET/CT result.
case_images: CRIPA2018-8031253.002.jpg
case_images: PMC6076899_01_CRIPA2018-8031253.002.jpg
case_images: fig2
case_images: Following the biopsies, the physician in charge ordered a PET/CT after reviewing the biopsy results in order to evaluate tumor size and potential metastasis (Figure 2).