case_images: PMC9715957_01
case_images: Initial CT scan demonstrating UESL. 20 x 10 x 10 cm well-circumscribed, solid mass of the entirety of the left lobe of the liver with relative sparing of the right lobe. Initial PET/CT demonstrating large hepatic mass measuring 25 x 13 cm with maximal SUV 11.5 as well as areas of necrosis, demonstrated by lack of FDG avidity.
case_images: fonc-12-1004108-g001.jpg
case_images: PMC9715957_01_fonc-12-1004108-g001.jpg
case_images: f1
case_images: Abdominal computed tomography (CT) revealed a solitary 20 x 10 x 10 cm well-circumscribed, highly vascularized hepatic mass in the entirety of the left lobe with relative sparing of the right lobe ( Figure 1 ). Positron emission tomography (PET) Scan redemonstrated this hepatic mass demonstrating intense FDG uptake of SUV 11.5 and areas of necrosis ( Figure 1 ).
case_images: (A) Oval to stellate tumor cells with ill-defined cell borders loosely distributed in myxoid stroma with marked nuclear pleomorphism, hyperchromasia and brisk mitotic activity. (B) Tumor cells within a fibroinflammatory background showing marked nuclear pleomorphism, hyperchromasia, and frequent multinucleated and bizarre giant cells. Cytoplasmic and extracellular eosinophilic globules noted.
case_images: fonc-12-1004108-g002.jpg
case_images: PMC9715957_01_fonc-12-1004108-g002.jpg
case_images: f2
case_images: Ultrasound guided core needle biopsy identified a malignant spindle cell neoplasm consistent with diffuse embryonal sarcoma ( Figure 2 ).
case_images: CT scan after completion of neodjuvant chemotherapy. Significant improvement was visualized with a decrease in lesion size to 15 x 7.7 x 8.1 cm. PET scan after completion of neodjuvant chemotherapy demonstrating reduction in size of mass to 14.5 x 6.8 x 8.9 cm as well as decreased FDG avidty of SUV 5.4.
case_images: fonc-12-1004108-g003.jpg
case_images: PMC9715957_01_fonc-12-1004108-g003.jpg
case_images: f3
case_images: Repeat PET scan corroborated the decrease in tumor size and indicated a significant decrease in FDG uptake, with a maximum SUV of 5.4 ( Figure 3 ).