case_images: PMC6507262_01
case_images: (a) Axial T2 with fat saturation: large predominantly T2 hypointense mass in left hepatic lobe, T2 hyperintense scar internally, and heterogeneous liver parenchyma in the right lobe with suggestion of additional T2 hypointense masses. (b) Coronal postgadolinium LAVA: 19 min delay. Many of the masses retain hepatobiliary agent (Eovist) relative to the background liver on delayed series which suggests presence of functioning hepatocytes, typically seen in focal nodular hyperplasia, but can be seen in inflammatory subtype of adenomas and even well-differentiated HCC. Arrows designate multiple masses.
case_images: CRIPE2019-7983824.001.jpg
case_images: PMC6507262_01_CRIPE2019-7983824.001.jpg
case_images: fig1
case_images: A 15 x 11 x 14.5 cm heterogeneous mass within the left hepatic lobe with retention of hepatobiliary contrast was demonstrated on abnormal background liver parenchyma with multiple other similar appearing smaller masses in both hepatic lobes (Figures 1(a) and 1(b)).
case_images: (a) Photomicrograph of the large hepatic mass reveals a well-differentiated hepatocellular neoplasm with mild cytologic atypia. A single unpaired vessel is present at the right-hand side of the image (hematoxylin and eosin, 20x magnification). (b) The large hepatic mass shows a focally disrupted reticulin meshwork with thickened hepatocyte trabeculae, consistent with a well-differentiated hepatocellular carcinoma (reticulin stain, 20x magnification). (c) The explanted specimen reveals a large heterogeneous mass with areas of hemorrhage and necrosis, occupying nearly the entire left hepatic lobe (hepatocellular carcinoma arising from a hepatic adenoma). Multiple small hepatic adenomas are present within the right hepatic lobe (arrows).
case_images: CRIPE2019-7983824.002.jpg
case_images: PMC6507262_01_CRIPE2019-7983824.002.jpg
case_images: fig2
case_images: Within the left hepatic lobe adenoma (19.5 x 9.8 x 9.5 cm) (Figure 2(c)), hepatocytes with mild cytologic atypia were found in areas of reticulin disruption, consistent with well-differentiated HCC arising from a hepatic adenoma with areas of macrovesicular steatosis and scattered foci of extramedullary hematopoiesis. This was supported by a reticulin stain demonstrating an intact reticulin meshwork, absent glypican-3 staining, and a low Ki-67 proliferation index (Figures 2(a) and 2(b)).