case_images: PMC5494576_01
case_images: Ultrasonography and computed tomography. US revealed a 14 x 10 mm well-defined, hypoechoic mass (arrow) in the posterosuperior subsegment of the right hepatic lobe (segment 7) (a). Plain CT shows a low-density mass at the right hepatic lobe (arrow) (b). The tumor was enhanced in the arterial phase (c) and washed out in the portal phase (d).
case_images: CRIS2017-8231943.001.jpg
case_images: PMC5494576_01_CRIS2017-8231943.001.jpg
case_images: fig1
case_images: Enhanced computed tomography (CT) revealed a 17 mm well-defined tumor that was enhanced in the arterial phase and washed out in the portal and delayed phase (Figure 1).
case_images: Magnetic resonance imaging. T1-weighted fat suppressed imaging showed low intensity at the tumor of S7 (arrow) (a). T2-weighted imaging showed high intensity at the tumor (b). In Gd-EOB-DTPA enhanced MRI, the tumor was enhanced in the arterial phase (c), and there was low signal intensity in the hepatobiliary phase (d).
case_images: CRIS2017-8231943.002.jpg
case_images: PMC5494576_01_CRIS2017-8231943.002.jpg
case_images: fig2
case_images: In Gd-EOB-DTPA enhanced MRI, the tumor was enhanced in the arterial phase, and there was low signal intensity in the hepatobiliary phase (Figure 2).
case_images: Macroscopic and pathological examinations. The lesion was not recognized by macroscopic examination of the cut surface of the surgically resected liver (a). Microscopically, the tumor is surrounded by the thin fibrous capsule (arrow) (b) (Hematoxylin and Eosin stain x100). The lesion was composed of epithelioid cells with a microvesicular cytoplasm that formed nests or cords with abundant capillary vessels (c) (Hematoxylin and Eosin stain x400).
case_images: CRIS2017-8231943.003.jpg
case_images: PMC5494576_01_CRIS2017-8231943.003.jpg
case_images: fig3
case_images: The macroscopic findings revealed that the tumor was visually not apparent (Figure 3(a)). Microscopic findings showed that the tumor was surrounded by thin fibrous capsule (Figure 3(b)). The lesion was composed of cells with a microvesicular cytoplasm, and these were aligned in alveolar or trabecular arrangements in a similar manner to features of the adrenocortical tissue (Figure 3(c)).
case_images: Immunohistochemical staining. Immunohistochemistry of the lesion. The cells are positive for inhibin alpha (a), CD56 (b), and synaptophysin (c), whereas cells were negative for chromogranin A (d) (all photomicrographs x400).
case_images: CRIS2017-8231943.004.jpg
case_images: PMC5494576_01_CRIS2017-8231943.004.jpg
case_images: fig4
case_images: In contrast, positive staining was observed for inhibin alpha, melan A, synaptophysin, and CD56 but not chromogranin A (Figure 4).