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case_images: Dynamic computed tomography (CT) findings. (a) Two years ago, cystic tumors were detected as low-density lesions surrounded by contrasting tissue in segments 6 (S6) and 7 (S7). (b) Preoperative CT shows both tumors had enlarged slightly.
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case_images: Two years earlier, dynamic computed tomography (CT) had detected multiple cystic tumors in segments 6 (S6) and 7 (S7), which were subsequently monitored (Fig. 1a). Dynamic CT identified two low-density tumors with peripheral enhancement in the portal phase, featuring cyst-like internal septa (Fig. 1b), which showed slow enlargement over 2 years.
case_images: Magnetic resonance imaging findings. Known tumors are visible in S6, S7, and an additional tumor is found at the S7/8 boundary. These tumors appeared as low-intensity lesions on (a) T1-weighted images and (b) high-intensity lesions on T2-weighted images.
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case_images: Additionally, a 7-mm lesion was observed at the S7/8 boundary (Fig. 2a and b).
case_images: Positron emission tomography-computed tomography findings. Abnormal tracer accumulation are observed in the S6 and S7 tumors.
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case_images: Positron emission tomography-CT (PET-CT) showed abnormal uptake in S6 and S7 tumors but not in the S7/8 lesion (Fig. 3).
case_images: Computed tomography during hepatic arteriography findings. (a) Known tumors in S6, S7, and S7/8 exhibit peripheral contrast enhancement but lack contrast in their centers. (b) The new tumor in S8 displays a distinct, uniform contrast effect.
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case_images: CT during hepatic arteriography (CTHA) demonstrated well-contrasted tumors at the periphery, with no contrast enhancement in the center (Fig. 4a). Moreover, CTHA detected a new tumor in S8, displaying clear and uniform contrast but not visible with other imaging modalities (Fig. 4b).
case_images: Resected gross specimens. All tumors with brownish areas are indicated by yellow arrows. Tumor in S6 with cavities.
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case_images: According to the pathology report, all four lesions were fully resected (Fig. 5).
case_images: Histopathological findings. (a) Hematoxylin-eosin staining shows pleomorphic nuclei and dense chromatin in tumor cells, as well as cyst-like structures likely formed by exfoliated tumor cells. (b) Immunopathological examination: Tumor cells are positive for chromogranin A, synaptophysin, somatostatin receptor type 2 (SSRT2). Ki-67 is positive in 4% of tumor cells.
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case_images: Cyst-like structures were likely formed owing to tumor-cell spillage, leading to central necrosis (Fig. 6a). Ki-67 was positive in 4% tumor cells (Fig. 6b).