case_images: PMC11779615_01
case_images: CT and Contrast-enhanced CT imaging images. (A, E) Non-contrast-enhanced CT, (B, F) enhanced CT-arterial phase, (C, G) enhanced CT-venous phase, and (D, H) enhanced CT-delayed phase. (A) The non-contrast-enhanced CT scan of the abdomen showed an irregular mass in the right lobe of the liver with unclear borders and uneven density. (B-D) Enhanced CT scan showed heterogeneous delayed enhancement at the margin of the lesion in the right lobe of the liver,with areas of nonenhanced necrosis in the central area of the lesion. (E) CT scan revealed a subcutaneous nodule on the right back. (F-H) Enhanced CT showed circular enhancement.
case_images: fonc-14-1474105-g001.jpg
case_images: PMC11779615_01_fonc-14-1474105-g001.jpg
case_images: f1
case_images: CA125 (43.6 U/ml, reference range: 0-35 U/ml), elevated CA199 (>1000.0 U/ml, reference range: 0-27 U/ml), and elevated SF (582.7 ng/ml, reference range: 30-400 ng/ml), while other laboratory tests did not show any significant abnormalities. CT scan of the upper abdomen showed an irregular mass in the right lobe of the liver, measuring about 7.8cmx6.4cmx6.3cm, with unclear borders and uneven densities ( Figure 1A ), and multiple nodules could be seen in the subcutaneous area of the chest and abdomen ( Figure 1E ) as well as in the peritoneum. CT scan showed heterogeneous delayed enhancement at the margin of the lesion in the right lobe of the liver, with areas of nonenhanced necrosis in the central area of the lesion ( Figures 1B-D ), and partial circular enhancement in the subcutaneous thoracic dorsal area ( Figures 1F-H ) and peritoneal nodes. Combining the clinical and imaging features, it was suspected that there was an intrahepatic malignant tumor with multiple metastases.
case_images: 18F-FDG PET/CT images. (A) Maximum intensity projection (MIP) image demonstrated multiple lesions with abnormally elevated FDG uptake. Axial CT (B, red arrow) and transaxial fused PET-CT images (C, red arrow) showed a strong increased 18F-FDG uptake in the right lobe lesion of the liver. Transaxial fusion PET-CT images showed multiple hypermetabolic lesions in the abdominal subcutaneous tissue (C, white arrow), peritoneum (E), femur (G), right breast (I), and some skeletal muscles (K, M). Corresponding CTs of part of the skeletal muscles (J, L) and the left upper femur (F) did not reveal significant abnormal density shadows.
case_images: fonc-14-1474105-g002.jpg
case_images: PMC11779615_01_fonc-14-1474105-g002.jpg
case_images: f2
case_images: Many lesions with abnormal FDG uptake were observed on the whole-body maximum intensity projection image ( Figure 2A ).In addition to foci of increased FDG metabolism in the right lobe of the liver (SUVmax15.3;  Figures 2B, C , red arrow), thoracic and abdominal subcutis (SUVmax7.6;  Figures 2B, C , white arrow), and peritoneum (SUVmax7.9;  Figures 2D, E ), the PET-CT axial fusion image also demonstrated increased metabolism in the left upper femur (SUVmax10.3;  Figures 2F, G ), right breast (SUVmax1.5;  Figures 2H, I ), right upper arm (SUVmax8.9;  Figures 2J, K ), and bilateral gluteal muscles (SUVmax15.8;  Figures 2L, M ) with multiple FDG hypermetabolic nodules, and the corresponding CTs of part of the skeletal muscles ( Figures 2J-M ) and the left upper femur ( Figures 2F, G ) did not show apparent abnormal density shadows.
case_images: Pathologic picture. (A) Hepatic puncture biopsy pathology revealed hypo-differentiated cholangiocarcinoma. (B) Pathology of the dorsal mass showed metastatic adenocarcinoma.
case_images: fonc-14-1474105-g003.jpg
case_images: PMC11779615_01_fonc-14-1474105-g003.jpg
case_images: f3
case_images: Pathologic images of the patient's hepatic puncture biopsy ( Figure 3A , HE staining; The original magnification of 10x20) showed Hypo-differentiated cholangiocarcinoma. An ultrasound-guided puncture biopsy of the dorsal mass was performed, and the pathologic images ( Figure 3B , HE staining; The original magnification was 10 x 10) suggest metastatic adenocarcinoma.