case_images: PMC5836184_01
case_images: Noncontrast CT revealed mild liver enlargement, and 2-8 cm round-shaped lesions with regular contour and central hypodensity, disseminated throughout the liver, are observed. This is suggestive of intrahepatic metastases or multifocal HCC.
case_images: crg-0012-0019-g01.jpg
case_images: PMC5836184_01_crg-0012-0019-g01.jpg
case_images: F1
case_images: Abdominal computed tomographic (CT) scan showed mild hepatomegaly, perihepatic and flank fluid, and multiple hypodense liver lesions suggestive of intrahepatic metastases or multifocal HCC (Fig. 1).
case_images: Surgical aspect of one of the two actively bleeding liver tumors.
case_images: crg-0012-0019-g02.jpg
case_images: PMC5836184_01_crg-0012-0019-g02.jpg
case_images: F2
case_images: At emergency laparotomy, 2,800 mL of blood in the abdominal cavity were discovered; two actively bleeding liver tumors in segments III and VI, and multiple small nonbleeding tumors were observed (Fig. 2).
case_images: a Histologic examination showed acidophilic and polygonal neoplastic cells, with a solid pattern and bile pigment formation in an intracytoplasmic cumulus. Histologic elements are suggestive of HCC. Hematoxylin and eosin stain, x40. b Immunohistochemical analysis revealed intracytoplasmic positive reactivity for alpha-fetoprotein in neoplastic liver cells. Immunoperoxidase stain, x10.
case_images: crg-0012-0019-g03.jpg
case_images: PMC5836184_01_crg-0012-0019-g03.jpg
case_images: F3
case_images: Histopathologic analysis reported HCC and absence of cirrhotic changes (Fig. 3).