case_images: PMC10757360_01
case_images: Imaging and endoscopic pictures. Preoperative abdominal enhanced MR, arterial phase, The tumor does not exhibit significant enhancement and shows lower signal intensity compared to the surrounding hepatic parenchyma (A) Preoperative abdominal enhanced MR, venous phase, the tumor periphery exhibits mild enhancement, while the central region demonstrates significantly lower signal intensity compared to the surrounding hepatic parenchyma (B) Preoperative abdominal enhanced MR, T2WI, the tumor demonstrates a long T2 signal, with signal intensity higher than the surrounding hepatic parenchyma (C) Preoperative abdominal enhanced MR, DWI, the tumor exhibits restricted diffusion (D) Abdominal CT on the 5th day postoperative, no significant fluid accumulation observed in the hepatic periphery or intra-abdominal cavity (E) Abdominal enhanced MR in the arterial phase and venous phases, 3 months postoperatively, Imaging reveals an irregular soft tissue mass in the hepatic hilum area following left hepatectomy. Enhanced scanning shows mild, uneven enhancement. Blurring is observed in the hepatic periphery, peritoneum, and abdominal fat interspace, with multiple nodules displaying heterogeneous enhancement within (F, G) Endoscopic placement of a nasojejunal nutritional tube (H).
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case_images: Following admission, an abdominal enhanced magnetic resonance imaging (MRI) indicated a mass in the left lobe of the liver, intrahepatic bile duct dilation, and enlarged surrounding lymph nodes ( Figures 1A-D ). On the 5th day post-surgery, an abdominal CT scan revealed no significant peritoneal or perihepatic fluid accumulation ( Figure 1E ). Subsequent abdominal enhanced MRI indicated a mass in the porta hepatis region, along with multiple enlarged lymph nodes around the liver, in the abdominal cavity, and retroperitoneally, suggesting recurrence ( Figures 1F, G ). Nasojejunal catheterization was done via endoscopy to support enteral nutrition ( Figure 1H ).
case_images: Intraoperative pictures. The blue arrow designates right anterior branch of the portal vein, the yellow arrow denotes common bile duct.
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case_images: The surgery lasted for 3.5 hours, with an estimated intraoperative blood loss of approximately 100ml ( Figure 2 ).
case_images: Pathological images and immunohistochemistry staining were conducted as follows: Tumor tissue sections stained (HE x400), The tumor cells exhibit a pattern of solid nests, glandular formations, and reticular arrangements. Some of the nest formations show central keratinization. The cells possess abundant cytoplasm, large and deeply stained nuclei, and notable cellular atypia (A, x400); CK-7 immunohistochemical staining exhibited diffuse positivity (B, x400); CK-19 immunohistochemical staining exhibited diffuse positivity (C, x400); CK-20 immunohistochemical staining displayed diffuse positivity (D, x400); P40 immunohistochemical staining showed partial positivity (E, x400); Ki-67 positive index is approximately 70%. (F, x400).
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case_images: Microscopic examination ( Figures 3A-F ) revealed tumor cells exhibiting both nest-like and glandular structures.
case_images: Graph illustrating the changing trends of ALT (A), TBIL (B), and CA19-9 (C) during treatment.
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case_images: AST and TBIL gradually returned to normal levels, while serum CA19-9 significantly decreased ( Figure 4 ). TBIL level 146 umol/L, CA19-9 level 357 U/L ( Figure 4 ). The tumor compressed the biliary duct at the porta hepatis, causing obstructive jaundice, and also exerted pressure on the duodenum, resulting in upper gastrointestinal obstruction.