case_images: PMC10949526_01
case_images: An abdominal computed tomography scan confirmed an extremely large mixed-density mass measuring approximately 13 * 10.1 * 9.2 cm located in the right liver with intratumoral hemorrhage. The tumor exhibited an enhancement pattern as fast-in and fast-out (A,B). After 3 months of neoadjuvant therapy, most of the mass was necrotic, with iodine oil deposition (red arrow) and slight local enhancement (C,D).
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case_images: fig1
case_images: An enhancement pattern, such as fast-in or fast-out, was also observed (Figures 1A,B).
case_images: Changes in magnetic resonance imaging and AFP levels during patient treatment After 3 months of neoadjuvant therapy, MRI revealed that most of the lesion was necrotic, with slight local enhancement (A). The overall clinical development/diagnosis timeline (B).
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case_images: fig2
case_images: Furthermore, magnetic resonance (MRI) confirmed the presence of the lesion, which was hyperintense at T2 and had significant uneven enhancement (Figure 2A). MRI (after 3 months) revealed a large mass in the right lobe of the liver, with a length of approximately 120 * 83 * 82 mm. Most of the lesions were necrotic, with iodine oil deposition and slight local enhancement (Figure 2A). AFP decreased to 5.9 ng/mL (Figure 2B). Tumors (mRECIST; Figure 2A). After multidisciplinary discussion, the hepatic cancer and adherent part of the diaphragmatic pleura were resected. The patient recovered well after surgery, without any postoperative complications.
case_images: Postoperative histopathological examination revealed a high-grade spindle cell tumor with rhabdomyoblasts (white arrow) and focal cartilaginous components accompanied by tumor-like bone tissue (A,B). Immunohistochemical analysis revealed that the fusiform cells were positive for Desmin (C), CD34 (D), MyoD1 (E) and myogenin (F) but negative for H3K27me3 (G), S100 (H) and SMA (I).
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case_images: PMC10949526_01_fmed-11-1361690-g003.jpg
case_images: fig3
case_images: Interestingly, histopathological examination revealed a high-grade spindle cell tumor, with rhabdomyoblasts and focal cartilaginous components accompanied by tumor-like bone tissue (Figures 3A,B). Immunohistochemical analysis (Table 1) revealed that the fusiform cells were positive for myogenic markers (MyoD1 and myogenin), CD34, EMA and Desmin, as well as the loss of H3K27me3 (Figures 3C-I).