case_images: PMC8415301_01
case_images: (A) Grayscale ultrasound showed a hypoechoic nodule with peripheral hypoechoic halo and centrally anechoic area in the hepatic segment VI. (B) Color Doppler flow imaging (CDFI) displayed dot-linear blood flow signals within the liver nodule. In the contrast-enhanced ultrasound (CEUS), (C) the solid component of the nodule presented rapidly homogeneous hyper-enhancement in the arterial phase. (D) The enhancement of the nodule was washed out slowly and gradually, with heterogenous mild enhancement in the portal phase. (E) In the late phase (4 min after contrast agent injection), the nodule showed slight hypo-enhancement, and the hypo-enhanced area was mainly located in the surrounding space. There was a small piece of non-enhanced area (arrows) within the lesion center in the whole three-phase imaging.
case_images: fmed-08-602346-g0001.jpg
case_images: PMC8415301_01_fmed-08-602346-g0001.jpg
case_images: F1
case_images: The lesion had an approximate size of 2.7 cm x 2.2 cm, with an almost regular shape and slightly clear margins; small patches of anechoic area were detected within the tumor (Figure 1A). Color Doppler flow imaging (CDFI) showed dot-linear blood flow signals within the liver nodule (Figure 1B). In the arterial phase, the solid component of the nodule presented rapidly homogeneous hyper-enhancement (Figure 1C), without rim-like enhancement. The nodule appeared heterogeneous, with mild enhancement in the portal phase (Figure 1D), and slight hypo-enhancement was detected in the late phase. The hypo-enhanced area was mainly located in the surrounding space (Figure 1E).
case_images: Findings of magnetic resonance imaging (MRI). (A) T1-weighted image of the nodule showed an iso-intensity lesion. (B) In the arterial phase, the lesion was significantly enhanced, and there was wash out both in the portal phase (C) and late phase (D). (E) T2-weighted image of the tumor presented a slightly higher intensity. (F) Diffusion-weighted image of the tumor was a marked hyper-intensity. (G) ADC showed a low-signal lesion.
case_images: fmed-08-602346-g0002.jpg
case_images: PMC8415301_01_fmed-08-602346-g0002.jpg
case_images: F2
case_images: The nodule showed high enhancement in the arterial phase and low density after wash-out of the contrast medium in the portal and delayed phases (Figure 2).
case_images: (a) Microscopy showed that the tumor consisted of two components: a hepatocellular carcinoma (HCC) and a neuroendocrine carcinoma (NEC) (H&E staining, x100). (b-f) Immunohistochemical staining displayed CD56(+), CgA(+), Syn(+), HEPA(+), and GPC-3 expression (x100).
case_images: fmed-08-602346-g0003.jpg
case_images: PMC8415301_01_fmed-08-602346-g0003.jpg
case_images: F3
case_images: Microscopic examination revealed that the tumor consisted of two components: a HCC and a NEC (Figure 3a). Immunohistochemistry showed positive CD56, positive chromogranin A (CgA), positive synaptophysin (Syn), strongly positive HEPA, and positive GPC-3 expression (Figures 3b-f).