case_images: PMC6240724_01
case_images: (A) Doppler ultrasonogram showing hyperechogenic, cystic, and hypervascular hepatic perivascular epithelioid cell tumor. (B) Computed tomography scan of tumor.
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case_images: On ultrasonography there was a hypoechoic, solid mass with sharp contours and heterogenous pattern which had a size of 16 x 10 cm and diffuse cystic-degenerative areas and which appears hypervascular on Doppler USG (Fig. 1A). A giant hepatic adenoma was primarily considered in the differential diagnosis, which also included liver tumors of mesenchymal origin or hepatocellular carcinoma on a non-cirrhotic basis (Fig. 1B).
case_images: (A) Intraoperative view of tumor mass. (B) View of surgical margin. (C) Size of tumor mass. (D) Postoperative cross-sectional area of the liver.
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case_images: There was no additional lesion in the abdominal cavity (Fig. 2).
case_images: (A) Tumor areas infiltrating the hepatic parenchyma (shown with yellow arrow). (B) Perivascular epithelioid cells with round to ovoid nuclei and abundant eosinophilic cytoplasm, which are occasionally spindle-shaped but mostly epithelioid (shown with yellow arrow). (C) Diffuse positive immunohistochemical staining in cytoplasmic area for HMB-45. (D) Diffuse positive immunohistochemical staining in cytoplasmic area for smooth muscle actin.
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case_images: Sections prepared from the tumor showed that it was separated from the adjacent hepatic parenchyma with a clear border but showed infiltration of the parenchyma in a few foci (Fig. 3A). The tumor was highly cellular, the components of which were spindle in shape from place to place and epithelioid in most areas, and they had round-ovoid nuclei and abundant eosinophilic cytoplasm (Fig. 3B). There was diffuse cytoplasmic positivity with HMB-45 (Fig. 3C) and SMA (Fig. 3D).
case_images: Computed tomographic follow-up image 10 months after surgery.
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case_images: She is under follow-up without recurrence 10 months after the surgery (Fig. 4).