case_images: PMC10294241_01
case_images: a Arterial-phase CT scan in coronal plane of the thoracic and abdominal cavity showing extensive HCC in the right lobe of the liver with a TT invading the IVC (white arrows). b Venous-phase CT scan in coronal plane of thoracic cavity showing TT in RA (white arrow).
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case_images: F1
case_images: Another node (6 x 4.5 x 9 cm) was situated at the level of hepatic venous confluence with an intraluminal mass extending from the right hepatic vein through the IVC to the RA (Fig. 1).
case_images: Preoperative echocardiogram revealed the 2.63 cm mass or thrombus occupying the RA without tricuspid involvement nor being of the pedunculated type (white arrow).
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case_images: F2
case_images: TT (2.63 cm) within the RA entering from the IVC had no signs of reaching the tricuspid valve or being that of the pedunculated type (Fig. 2). The atriums and ventricles on both sides were normal in size with a preserved right and left ventricular systolic function.
case_images: Remnant liver volume: arterial-phase CT scan in axial plane of abdominal cavity showing computed functional volume of liver segments.
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case_images: F3
case_images: Operative specimens. a, b Gross view of the tumor. c, d Tumor growth into large veins in gross examination.
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case_images: F4
case_images: The largest of them was 13 x 11 x 14 cm (Fig. 4). Microscopic examination of the resected tumor revealed multifocal grade 2/3 HCC, clear cell variant with the microvascular and macrovascular invasion (Fig. 4).
case_images: Pathological findings of HCC, clear cell (CC) variant. a Hematoxylin and eosin (HE) stain, original magnification (OM), x40. b HCC, CC variant, HE stain, OM, x100. Immunohistochemical findings of HCC. c HCC proliferation activity with Ki67, immunoperoxidase, OM, x100. d HCC, CC variant, immunoperoxidase (HepPar1), OM, x100.
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case_images: F5
case_images: Ki-67 proliferation fraction showed rates from 5% to 25% in malignant HCC cells (Fig. 5).