case_images: PMC10733019_01
case_images: (a-c) PET-CT with 18F-PSMA. Axial (a) and 3D (c) PET images demonstrate a large focus of markedly and heterogeneously increased radiotracer uptake in the left lobe of the liver. Unenhanced low-dose CT image at the corresponding level with narrow window demonstrates a subtle hypodense ill-defined nodule anteriorly in the left hepatic lobe (arrow).
case_images: CRIS2023-1458175.001.jpg
case_images: PMC10733019_01_CRIS2023-1458175.001.jpg
case_images: fig1
case_images: Despite being clearly visible on the PET portion of the study, corresponding CT images of the liver only showed a subtle, ill-defined abnormality in the left hepatic lobe (Figure 1).
case_images: (a-c) MRI of the abdomen. Coronal T2 HASTE image (a) demonstrates a round focus of subtly increased T2 signal in the anterior left hepatic lobe (arrow). Axial gradient echo opposite phase image (b) demonstrates a round focus of decreased signal in the anterior left hepatic lobe (arrow). Axial fat-suppressed T1 image (c) shows the lesion with portal venous washout represented by decreased enhancement in comparison to the surrounding healthy hepatic parenchyma, a feature suspicious for malignancy. Of note, this hepatocellular carcinoma did not demonstrate the more typical arterial enhancement.
case_images: CRIS2023-1458175.002.jpg
case_images: PMC10733019_01_CRIS2023-1458175.002.jpg
case_images: fig2
case_images: A kidney/adrenal MRI study obtained to better characterize this hepatic lesion and to rule out RCC recurrence demonstrated an area of increased T2 signal in the liver corresponding to the PSMA PET abnormality without other pathologic intra-abdominal findings (Figure 2).
case_images: Moderately differentiated hepatocellular carcinoma is seen on the left while the adjacent uninvolved liver parenchyma is unremarkable. PSMA immunohistochemistry was positive only in tumor sinusoid and negative in the surrounding tissue H&E stain, original magnification 100x.
case_images: CRIS2023-1458175.003.jpg
case_images: PMC10733019_01_CRIS2023-1458175.003.jpg
case_images: fig3
case_images: Pathology examination confirmed the diagnosis of moderately differentiated hepatocellular carcinoma in the setting of a noncirrhotic liver (Figure 3).
case_images: Immunoperoxidase stain for PSMA highlights diffusely positive stain on sinusoidal endothelial cells in the tumor while the uninvolved liver parenchyma is negative. Original magnification 100x.
case_images: CRIS2023-1458175.004.jpg
case_images: PMC10733019_01_CRIS2023-1458175.004.jpg
case_images: fig4
case_images: PSMA demonstrated diffusely highlighted sinusoidal endothelial cells (Figure 4). PSMA immunohistochemistry was positive only in tumor sinusoid and negative in the surrounding tissue.