case_images: PMC4293549_01
case_images: Arterial-phase helical computed tomography showed a 3.8-cm rim-enhancing, centrally hypodense lesion in segment 4 of the liver.
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case_images: PMC4293549_01_kjim-30-110-g001.jpg
case_images: F1
case_images: C were negative. Computed tomography (CT) of the chest and abdomen did not demonstrate lesions in the lungs but did show a 3.8-cm centrally hypodense lesion with rim enhancement in segment 4 of the liver (Fig. 1).
case_images: Magnetic resonance imaging findings in the liver showed a round nodule with a low signal intensity (arrow) on T1-weighted images (A) and a high signal intensity (arrow) on T2-weighted images (B) in the left hepatic lobe.
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case_images: PMC4293549_01_kjim-30-110-g002.jpg
case_images: F2
case_images: Gadoxetate-disodium-enhanced magnetic resonance imaging 10 days after hospitalization showed low T1 and high T2 signal intensities, rim-like arterial enhancement, and a washout lesion in the left lobe of the liver (Fig. 2).
case_images: Microscopic findings of the tumor. Hematoxylin and eosin staining showed poorly differentiated malignant cells suggestive of adenocarcinoma (A, x100; B, x400). Positive staining of the tumor cells for (C) cytokeratin 7 (x100) and (D) cytokeratin 19 (x100) was seen on immunohistochemical examination.
case_images: kjim-30-110-g003.jpg
case_images: PMC4293549_01_kjim-30-110-g003.jpg
case_images: F3
case_images: Microscopic examination showed poorly differentiated malignant cells positive for cytokeratin (CK) 7 and CK19 and negative for CK20 and hepatocyte-specific antigen (Fig. 3), suggestive of CCC.
case_images: Computed tomography of the chest showed newly developed multiple pulmonary nodules (black arrows) suggestive of metastasis.
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case_images: PMC4293549_01_kjim-30-110-g004.jpg
case_images: F4
case_images: Preoperative chest CT revealed multiple new metastatic lung nodules (Fig. 4), which had not been seen 2 months earlier, and surgery was therefore postponed.
case_images: The clinical course of body temperature and white blood cell (WBC) counts beginning from initial hospitalization. CT, computed tomography; MRI, magnetic resonance imaging.
case_images: kjim-30-110-g005.jpg
case_images: PMC4293549_01_kjim-30-110-g005.jpg
case_images: F5
case_images: The patient's condition deteriorated progressively despite supportive management, and his WBC count increased to 62,000/microL (Fig. 5).