case_images: PMC11137254_01
case_images: (A) Abdominal computed tomography (CT) scan showed a circular low-density shadow near the gallbladder fossa in the right lobe of the liver (arrow); moreover, the volume of the left lobe of the liver increases, the ratio of the left and right lobes is unbalanced, and the widening of the liver cleft can also be seen, suggesting cirrhosis; (B) In the arterial phase of contrast-enhanced CT scan, the lesion showed uneven enhancement, mainly with peripheral enhancement of the lesion (arrow); During the portal vein phase (C) and delayed phase (D), the degree of enhancement of the lesion gradually declines (arrows).
case_images: fmed-11-1408967-g001.jpg
case_images: PMC11137254_01_fmed-11-1408967-g001.jpg
case_images: fig1
case_images: The contrast-enhanced scan was performed with iohexol [300 mg I/mL]1.5 mL/kg, and a single phase injection at a rate of 3.0 mL/s was performed with a high pressure syringe) showed a circular low-density lession near the gallbladder fossa in the right lobe of the liver, with uneven mild enhancement on contrast-enhanced scanning (as shown in Figure 1); Moreover, CT showed that the left and right lobes of the liver were disproportioned, the left lobe was enlarged, and the liver fissure was widened, suggesting possible cirrhosis. The MRI (GE 3.0 T Signa HDxt superconducting magnetic resonance instrument, with abdominal coil; Conventional T1WI and T2WI sequence plain scan and contrast-enhanced scan were performed; and the contrast-enhanced scan was intravenously injected with 0.1mmoL/kg meglumine gadopenate, and the injection flow rate was 3.0 mL/s) of the upper abdomen showed that the lesion presented equal signal on T1WI and slightly uneven high signal on T2WI (Figure 2).
case_images: On magnetic resonance imaging (MRI), the lesion showed equal signal on both in-phase (A) and out-phase (B) of T1-weighted imaging (T1WI, arrows), and uneven slightly higher signal on T2WI ((C), arrow). On contrast-enhanced T1WI, the lesion showed mild to moderate enhancement in arterial phase ((D), arrow), portal phase ((E), arrow) and delayed phase ((F), arrow), mainly peripheral enhancement.
case_images: fmed-11-1408967-g002.jpg
case_images: PMC11137254_01_fmed-11-1408967-g002.jpg
case_images: fig2
case_images: The contrast-enhanced scan was performed with iohexol [300 mg I/mL]1.5 mL/kg, and a single phase injection at a rate of 3.0 mL/s was performed with a high pressure syringe) showed a circular low-density lession near the gallbladder fossa in the right lobe of the liver, with uneven mild enhancement on contrast-enhanced scanning (as shown in Figure 1); Moreover, CT showed that the left and right lobes of the liver were disproportioned, the left lobe was enlarged, and the liver fissure was widened, suggesting possible cirrhosis. The MRI (GE 3.0 T Signa HDxt superconducting magnetic resonance instrument, with abdominal coil; Conventional T1WI and T2WI sequence plain scan and contrast-enhanced scan were performed; and the contrast-enhanced scan was intravenously injected with 0.1mmoL/kg meglumine gadopenate, and the injection flow rate was 3.0 mL/s) of the upper abdomen showed that the lesion presented equal signal on T1WI and slightly uneven high signal on T2WI (Figure 2).
case_images: (A) The maximum intensity projection of the positron emission tomography (PET)/computed tomography (CT) showed a lesion in the liver region with increased uptake of fluorine-18 fluorodeoxyglucose (18F-FDG), with a maximum standardized uptake value (SUVmax) of 8.5. Axial CT (B) showed the lesion in the right lobe of the liver (arrow). Axial PET (C) and PET/CT fusion image (D) showed obviously increased 18F-FDG uptake of the mass (arrows).
case_images: fmed-11-1408967-g003.jpg
case_images: PMC11137254_01_fmed-11-1408967-g003.jpg
case_images: fig3
case_images: In order to further evaluate the nature of the tumor and determine the optimal treatment plan for the patient, she underwent fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT examination (Biograph mCT, Siemens, Germany; The injection dose of 18F-FDG was 9.0 mCi [0.15 mCi/kg]), and the results revealed increased 18F-FDG uptake in the lesion, while no other increased radioactive uptake lessions were observed in the rest of body (Figure 3).
case_images: (A) Hematoxylin-eosin staining showed diffuse distribution of clear cells with abundant cytoplasm, centrally located nuclei and deep staining. Immunohistochemistry showed positive expression of tumor cells CK (B), Hep par1 (C), and Glypican (GPC3, (D)), HSP70 (partially, (E)), and Ki67 (about 40%, (F)). All images are 200 x magnification.
case_images: fmed-11-1408967-g004.jpg
case_images: PMC11137254_01_fmed-11-1408967-g004.jpg
case_images: fig4
case_images: Hematoxylin-eosin staining showed that most of the lesions were clear cells with rich and clear cytoplasm, and the nucleus was located in the center, deeply stained and irregular (Figure 4).