case_images: PMC6370147_01
case_images: EBV-related LELCC of Case 1 on B mode and CDFI images. (A) A 2.0 cm x 1.7 cm slightly heterogeneous hypoechogenic nodule located at the inferior segment of the left hepatic lateral lobe. (B) CDFI revealed no blood flow signals in the nodule. CDFI = color Doppler flow imaging, EBV = Epstein-Barr virus, LELCC = lymphoepithelioma-like cholangiocarcinoma.
case_images: medi-98-e14206-g001.jpg
case_images: PMC6370147_01_medi-98-e14206-g001.jpg
case_images: F1
case_images: Abdominal ultrasound demonstrated a slightly heterogeneous hypoechoic nodule in the background of normal hepatic parenchyma in segment 3 of the liver (Fig. 1A). Color Doppler flow imaging (CDFI) revealed no blood flow signals in this nodule (Fig. 1B).
case_images: PMC6370147_02
case_images: EBV-related LELCC of Case 2 on B mode, CDFI and CEUS images. (A) A 3.5cm x 2.5 cm slightly heterogeneous hypoechoic mass with peripheral hypoechoic halo located at the superior segment of the left hepatic lateral lobe. (B) CDFI revealed no blood flow signals in the mass. (C) The mass showed homogeneous hyperenhancement in the arterial phase. (D) The central enhancement washed out gradually, presenting hypoenhancement, and the periphery demonstrated rim-like slight hyperenhancement in the portal phase. (E) In the delayed phase, the enhanced presentation of the mass was similar to the portal phase. CDFI = color Doppler flow imaging, CEUS = contrast-enhanced ultrasound, EBV = Epstein-Barr virus, LELCC = lymphoepithelioma-like cholangiocarcinoma.
case_images: medi-98-e14206-g002.jpg
case_images: PMC6370147_02_medi-98-e14206-g002.jpg
case_images: F2
case_images: Gray-scale ultrasound image revealed a slightly heterogeneous hypoechoic mass measuring 3.5 cm x 2.5 cm with well-defined margin and regular shape at the superior segment of the left hepatic lateral lobe (Fig. 2A). CDFI showed no blood flow signals in the mass (Fig. 2B). Using surrounding liver parenchyma as a reference, the mass was homogeneous hyperenhancement in the arterial phase (Fig. 2C). In the portal phase and late phase (Fig. 2D and E), the center enhancement of the mass washed out gradually, presenting hypoenhancement, while the periphery demonstrated rim-like slight hyperenhancement.
case_images: EBV-related LELCC of Case 2 on CECT images. (A) Noncontrast CT showed a 3.0 cm x 2.8 cm slight hypodense mass with peripheral rim-like hyperdense in the segment 2 of the liver. (B) In the arterial phase, the periphery of the mass demonstrated slight hyperenhancement like a bright ring, the centripetal was isoenhancement. (C) The mass was slight hypoehancement with peripheral rim-like hyperenhancement in the portal phase. CDFI = color Doppler flow imaging, CECT = contrast-enhanced computed tomography, CT = computed tomography, EBV = Epstein-Barr virus, LELCC = lymphoepithelioma-like cholangiocarcinoma.
case_images: medi-98-e14206-g003.jpg
case_images: PMC6370147_02_medi-98-e14206-g003.jpg
case_images: F3
case_images: CECT was performed on this patient using a 64-channel multislice CT scanner (Royal Philips, The Netherlands) with iodinated contrast agent Ultravist (Bayer Schering Pharma, Berlin-Wedding, Germany). CECT showed a 3.0 cm x 2.8 cm slightly hypodense mass with peripheral rim-shape hyperdense and ill-defined margin in segment 2 of the liver (Fig. 3A). In the arterial phase, the peripheral part of the mass demonstrated slight hyperenhancement like a bright ring, the centripetal part of the mass was isoenhancement (Fig. 3B). The periphery of the mass still showed slight hyperenhancement, but the center washed out to hypoenhancement in the portal phase (Fig. 3C).