case_images: PMC9447363_01
case_images: T2-weighted images of liver MRI (TR/TE: 7059/85 ms; field of view: 44 x 40 cm; matrix: 320 x 224; thickness: 8 mm), which showed a giant heterogenous high signal intensity tumor mainly located in the left lobe (A, B, marked with arrows) and multiple small high signal intensity lesions in the right lobe (C, D, marked with arrows).
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case_images: PMC9447363_01_fonc-12-972306-g001.jpg
case_images: f1
case_images: Berlin, Germany) showed a giant hepatic lesion (16.2cm x 14.3cm x 10.3cm) mainly located in the left lobe and multiple small lesions in the right lobe ( Figure 1 ). Both arterial and portal phase showed heterogenous enhancement inside the giant lesion, meanwhile right hepatic artery and right branch of portal vein were both involved by the tumor ( Figure 2 ).
case_images: Contrast-enhance images of liver MRI (dose: 0.1 mmol/kg; injection rate: 2.0 ml/s; TR/TE: 3.6/1.7 ms; slice thickness: 5 mm; image matrix: 256 x 192; field of view: 40 x 44 cm; the scanning delay times were 20s, 60s and 180s for the arterial, portal and delay phases, respectively), which showed the involvement of right branch of portal vein (A, B, marked with arrows) and right hepatic artery (C, marked with arrow).
case_images: fonc-12-972306-g002.jpg
case_images: PMC9447363_01_fonc-12-972306-g002.jpg
case_images: f2
case_images: Berlin, Germany) showed a giant hepatic lesion (16.2cm x 14.3cm x 10.3cm) mainly located in the left lobe and multiple small lesions in the right lobe ( Figure 1 ). Both arterial and portal phase showed heterogenous enhancement inside the giant lesion, meanwhile right hepatic artery and right branch of portal vein were both involved by the tumor ( Figure 2 ).
case_images: Hematoxylin & eosin and immunohistochemical staining of the liver biopsy, which showed spindle-shaped tumor cells and epithelioid tumor cells (A, hematoxylin & eosin, x200), and positive for CD 31, CD34, ERG and Fli-1 (B-E, respectively, x200). The index rate of Ki-67 was 20% (F, x200).
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case_images: PMC9447363_01_fonc-12-972306-g003.jpg
case_images: f3
case_images: Tumor biopsy was then implemented and histological examination showed spindle-shaped tumor cells and epithelioid tumor cells ( Figure 3 ). Immunohistochemical staining showed that the tumor cells were positive for CD31, CD34, ERG and Fli-1, with a Ki-67 index rate of 20% ( Figure 3 ).
case_images: Comparison of the largest lesion on MRI before (A, D) and after the combined therapy of sirolimus and IFN-a 2b (B, C, E, F). The tumor (marked with black arrows) gradually regressed and the involved right branch of portal vein (marked with white arrows) got released from the tumor.
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case_images: PMC9447363_01_fonc-12-972306-g004.jpg
case_images: f4
case_images: MRI examination at the 8th month showed the largest tumor further regressed to 11.5cm x 9.0cm x 8.2cm and the small lesions were stable ( Figure 4 ).