case_images: PMC11236608_01
case_images: Axial enhanced CT images in a patient with HAS. (A-C) The CT scan revealed thickening of the gastric wall (arrow), with enhanced appearance in the gastric sinus area. The CT values of the lesion were 34 HU, 76 HU, and 54 HU in the unenhanced, arterial, and portal phases, respectively. (D-F) Multiple circular intensified lesions and nodes were observed in the peritoneum (straight arrow), along with heterogeneous enhancement in the retroperitoneal lymph nodes. Abundant fluid was seen in the abdominopelvic cavity. The lesion in the S5 liver segment exhibited marked heterogeneous enhancement (triangle). (G-I) The patient's CT images from 4 months earlier displayed multiple enhanced lesions encircling the liver during the arterial phase.
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case_images: A contrast-enhanced CT scan ( Figure 1 ) was conducted using a 128-row CT scanner (Siemens SOMATOM Definition AS). Supplementary Figure S1 ) indicated moderately differentiated adenocarcinoma, confirmed as HAS through immunohistochemistry. Staining for CK7, AFP, Her-2, PMS2, MLH1, MSH6, MSH2, and Ki-67 was positive, with a Ki-67 value of 80%.
case_images: Abdominal enhanced MR images in a patient with HAS. (A-H) Multiple nodular and mass-like abnormal lesions were detected in the liver. Some of these lesions appeared fused together with indistinct boundaries. They exhibited hyperintensity on T2WI images (A) and hypointensity on T1WI images (B, C). Notably, there was no substantial reduction in lesion intensity after fat saturation, indicating that the lesions lacked fat content. Significant diffusion restriction was also observed (D). The lesions displayed progressive enhancement (E-G), with the liver parenchyma demonstrating low signal intensity. Moreover, the small omental capsule, hepatoportal, and multiple retroperitoneal lymph nodes showed heterogeneous enhancement, and the reticulum displayed knot-like thickening with varying enhancement.
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case_images: f2
case_images: Upper abdominal enhanced magnetic resonance imaging (MRI) ( Figure 2 ) was performed using a 1.5-T system (GE
case_images: Contrast-enhanced ultrasound images in a patient with HAS: multiple regions exhibited echogenic enhancement during the late arterial phase, followed by attenuation in the portal phase and continued attenuation in the delayed phase. In the S5 liver segment, a mass (arrow) demonstrated a fast-in-fast-out pattern (A), remaining hypo-enhanced even after 3 min (B).
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case_images: f3
case_images: Contrast-enhanced ultrasound ( Figure 3 ) demonstrated multiple areas of increased echogenicity during the late arterial phase, with attenuation in the portal phase and further attenuation in the delayed phase.
case_images: Gastroscopy images in a patient with HAS: the gastroscopic examination revealed infiltrative hyperplastic foci located in the gastric sinus and gastric angle (arrow).
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case_images: f4
case_images: Gastroscopy ( Figure 4 ) revealed areas of infiltrative tissue growth in the gastric sinus and gastric angle.