case_images: PMC10836042_01
case_images: CT imaging of BAF. (A) An abdominal plain CT scan revealed a subcapsular solid-cystic mass with an obscure boundary (white arrow) in the liver segment II. The mass showed markedly heterogeneous enhancement in the (B) arterial phase, followed by wash-out in the (C) venous and (D) delayed phases. The arterial phase (B) also showed that the blood supply came from the left inter-hepatic artery and its branches.. BAF: Biliary adenofibroma.
case_images: cureus-0016-00000051575-i01.jpg
case_images: PMC10836042_01_cureus-0016-00000051575-i01.jpg
case_images: FIG1
case_images: Contrast-enhanced CT revealed a low-density mass of 4 cm x 4 cm in segment II of the liver, which showed heterogeneous enhancement on the arterial phase and wash-out on the portal venous and delayed phase (Figure 1).
case_images: MRI imaging of BAF. (A) T1-weighted image. (B) T2-weighted image. Contrast-enhanced MRI demonstrated markedly heterogeneous enhancement in the (C) arterial phase of the lesion but low signal in the (D) venous and (E) delayed phases. Diffusion and apparent diffusion coefficient (ADC) images (F and G) showed restricted diffusion. (H) Coronal (white arrow). The mass (B) had an obscure border (white arrow). The (C) arterial phase showed that the blood supply came from the left inter-hepatic artery and its branches (white arrow).. BAF: Biliary adenofibroma.
case_images: cureus-0016-00000051575-i02.jpg
case_images: PMC10836042_01_cureus-0016-00000051575-i02.jpg
case_images: FIG2
case_images: Diffusion-weighted imaging (DWI) sequence showed moderate hyperintensity, and the apparent diffusion coefficient (ADC) coefficient value was 1.260 x 10-3 mm2/s, which indicated that there was an obvious limitation to diffusion in the solid portion (Figure 2).
case_images: (A) The tumor was composed of tubuloglandular and microcytic structures embedded in a fibrous matrix. The green arrow shows the microcystic structures. The blue arrow shows the tubuloglandular structures (H&E, 100x). (B) The tumor areas were lined with cuboidal or low-columnar biliary epithelium. Nuclei were round or oval with small nucleoli, and cytoplasm showed without atypia (H&E, 200x). (C) In some areas, papillary projections were present in the lumens. The epithelial showed mild to severe atypical hyperplasia with columnar-type epithelium with elongated, hyperchromatic nuclei and nuclear crowding (H&E, 200x). (D) There was invasive growth in the adjacent parenchyma of the liver. The blue arrow shows normal liver tissue. The red arrow shows invasive growth tissue (H&E, 10x). (E) The malignant part of the tumor had an increased Ki-67 index (20%) (immunostaining, 200x). (F) p53 was negative (immunostaining, 200x).
case_images: cureus-0016-00000051575-i03.jpg
case_images: PMC10836042_01_cureus-0016-00000051575-i03.jpg
case_images: FIG3
case_images: The final histopathological diagnosis was BAF with invasive carcinoma (Figure 3).