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case_images: PMC11825378_02
case_images: Timeline of a 67-year-old patient with synchronous HCC and ICC with a DPM component.
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case_images: At the present admission, abdominal magnetic resonance imaging (MRI) revealed a hemoperitoneum that was caused by rupture of a liver tumor and emergent surgery was decided (Figure 1). TANDEM loaded with doxorubicin was performed. The patient is still alive 41 months after the first surgery (Figure 1).
case_images: Abdominal magnetic resonance imaging (MRI) indicates a tumor mass located in the sixth segment of the liver:(A) Hyperintense round/oval nodule in the right lobe; (B) heterogeneity appearance of the HCC; and (C) DWI shows diffusion restriction of the nodule.
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case_images: The tumor, which was called "tumor A," had low signal intensity on T1-weighted imaging (T1WI) and high intensity on T2WI, with arterial-enhancing and delayed wash-out and diffusion restriction as indicators of malignancy, suggesting an HCC (Figure 2).
case_images: The histopathological features of the two tumors of the liver, emphasized with hematoxylin and eosin staining. The tumor developed in S5-S6 of the liver:Moderately differentiated hepatocellular carcinoma (A, x40). The S4 resected tumor:Well-differentiated intrahepatic cholangiocarcinoma DPM type (B, x40).
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case_images: The tumor cells were polygonal in shape and exhibited nuclear atypia, with a high nucleocytoplasmic ratio, irregular nuclear membrane, multinucleation, and prominent nucleoli (Figure 3). The nuclei were vesicular, with fine chromatin and small nucleoli, scarce mitoses, a Ki67 index of 10%, and lymphatic invasion (Figure 3).
case_images: Immunohistochemical profile of HCC. The tumor cells reveal positivity for HepPar1 (A, x10), cytokeratin 8 (B, x10), and cytokeratin 18 (C, x10), without expression for cytokeratin 7 (D, x10); CD10 (E, x20) and CD34 (F, x20) are expressed in pericanalicular/perisinusoidal spaces.
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case_images: The histological and IHC patterns suggested the diagnosis of a moderately differentiated (G2) HCC (Figure 4).
case_images: Immunohistochemical profile of ICC-DPM type reveals positivity for cytokeratin 7 (A, x20) and cytokeratin 19 (B, x20), without expression for HepPar1 (C, x20).
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case_images: The tumor cells were marked by epithelial membrane antigen (EMA), CTK7, and CTK19, and did not express HepPar1 (Figure 5).
case_images: Peritumoral fibrosis, in HCC (A-C) and DPM component (D-F), revealed by Elastic-Van Gieson (A and D, x5) and Masson's trichrome stains (B and E, x5), and quantified with the ImageJ software:the Threshold option (C&F, x5).
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case_images: The amount of peritumoral fibrosis was highlighted with Elastic-Van Gieson and Masson's trichrome stains (Figure 6).