case_images: PMC11380813_01
case_images: Axial T2-weighted (a) and fat-saturated T2-weighted (b) magnetic resonance (MR) imaging scans show a multiple round hyperintense masses by "target sign" appearance with a more hyperintense central part (white arrows in a and b). In (c) and out (d) of phases of T1-weighted MR images reveal multiple hypointense masses in both lobes of the liver (red arrows in c and d).
case_images: JCIS-14-32-g001.jpg
case_images: PMC11380813_01_JCIS-14-32-g001.jpg
case_images: F1
case_images: They exhibited moderate hyperintensity on T2, with the largest ones displaying a "target sign" appearance (hyperintense center and moderately hyperintense outer part, which was hypointense on T1) [Figure 1].
case_images: On native (a) and arterial (b) phases of contrast-enhanced magnetic resonance imaging liver nodules are hypointense (white arrows in a and b), predominantly with mild-to-moderate central enhancement (red arrows in c and d) on portovenous (c) and delayed (d) (4 min) phases.
case_images: JCIS-14-32-g002.jpg
case_images: PMC11380813_01_JCIS-14-32-g002.jpg
case_images: F2
case_images: On post-contrast imaging, the liver lesions were hypovascular, showing mild-to-moderate centrifugal enhancement on arterial phase to delayed (4 min) phase [Figure 2].
case_images: Diffusion-weighted imaging in b-value of 800 s/mm2 (a) shows slightly hyperintense mass (white arrow) on the right lobe of the liver. The apparent diffusion coefficient (ADC) value of the lesion was 1.25 x 10-3 mm2/s. ADC map (b) of the liver lesion (white arrow).
case_images: JCIS-14-32-g003.jpg
case_images: PMC11380813_01_JCIS-14-32-g003.jpg
case_images: F3
case_images: Diffusion-weighted imaging (DWI) at b-value of 800, showing slightly hyperintense signal of the lesion [Figure 3a] corresponding apparent diffusion coefficient (ADC) map showing hyperintense signal of the lesion, ADC value of the lesion: 1.25 x 10-3 mm2/s [Figure 3b].
case_images: Coronal (a) and axial (b) venous phase magnetic resonance imaging demonstrates capsular retraction (white arrows in a and b).
case_images: JCIS-14-32-g004.jpg
case_images: PMC11380813_01_JCIS-14-32-g004.jpg
case_images: F4
case_images: Capsular retraction in the affected region was also noted [Figure 4].
case_images: The Fluorodeoxyglucose 18F (FDG)- Positron emission tomography/Computerised tomography (PET/CT) with axial fused PET/CT (a), axial (b) and coronal (c) PET scans revealed multiple metabolically active liver nodules (white arrows in a, c), predominantly involving the right lobe of the liver, with moderate heterogeneous FDG uptake of standardized uptake value (SUV) max 3.8 (b). No distant metastases were revealed.
case_images: JCIS-14-32-g005.jpg
case_images: PMC11380813_01_JCIS-14-32-g005.jpg
case_images: F5
case_images: However, fludeoxyglucose 18F (18-FDG) positron emission tomography/computed tomography (PET/CT) imaging revealed multiple metabolically active liver nodules with an SUVmax of 3.8 [Figure 5].
case_images: Hematoxylin-eosin staining of tumor demonstrates (a) irregular anastomosing vascular channels (x40, white arrows) (b) lined by atypical endothelial cells with hyperchromatic, enlarged nuclei (x100, red arrows).
case_images: JCIS-14-32-g006.jpg
case_images: PMC11380813_01_JCIS-14-32-g006.jpg
case_images: F6
case_images: Extensive necrosis and hemorrhages were evident [Figure 6].
case_images: Immunohistochemical staining: tumor cells were positive for (a) CD-31, x20 and (b) CD-34, x20.
case_images: JCIS-14-32-g007.jpg
case_images: PMC11380813_01_JCIS-14-32-g007.jpg
case_images: F7
case_images: Immunohistochemical analysis confirmed tumor cell positivity for endothelial markers CD-31 and CD-34 [Figure 7].
case_images: On contrast-enhanced computed tomography images after surgery (a) and 6 months after 4 courses of chemotherapy (b), the remaining undeleted nodules (white arrows in a) are visualized, the size of which increased slightly after 6 months (white arrows in b). Recovery of liver resection zones is noted. Recovery of liver resection zones (asterisks in a, b) is noted.
case_images: JCIS-14-32-g008.jpg
case_images: PMC11380813_01_JCIS-14-32-g008.jpg
case_images: F8
case_images: Follow-up CT scans revealed four remaining nodules located deeper in the liver [Figure 8a and b].