case_images: PMC11226333_01
case_images: Computed tomography imaging of the abdomen and pelvis without intravenous contrast showing transverse view of (a) homogeneous appearing liver on day 1 with subsequent development of (b) ill-defined hypodense lesions (arrows) with the largest lesion measuring 5.6 cm within the central liver on day 6 and (c) repeat imaging with IV contrast showing progression of disease with innumerable masses at 2 months.
case_images: CRIHEP2024-4950398.001.jpg
case_images: PMC11226333_01_CRIHEP2024-4950398.001.jpg
case_images: fig1
case_images: Infectious disease team was further consulted, and the patient underwent a repeat non-contrast CT scan of the abdomen and pelvis which then showed mildly enlarged liver measuring up to 21.3 cm with multiple ill-defined hypodense lesions within the liver which may reflect metastatic disease versus underlying primary malignancy (Figure 1(b)). Due to her condition, she was not a suitable candidate for oncologic therapies, resulting in the progression of hepatic lesions that quickly replaced most of the normal liver parenchyma (Figure 1(c)).
case_images: Histopathological examination of the right liver biopsy shows: (a) polygonal cells with eosinophilic cytoplasm, nuclear atypia, a high nuclear-to-cytoplasmic ratio, and prominent nucleoli (hematoxylin-eosin stain, x40 magnification); (b) hepatocyte plate thickening (reticulin stain, x40 magnification); and (c) strong and diffuse sinusoidal staining pattern (CD34 immunohistochemical stain, x40 magnification). Collectively, these findings are consistent with a diagnosis of HCC.
case_images: CRIHEP2024-4950398.002.jpg
case_images: PMC11226333_01_CRIHEP2024-4950398.002.jpg
case_images: fig2
case_images: The patient underwent USG biopsy of the liver with pathology confirming tumor comprised of polygonal cells (Figure 2).