case_images: PMC10425252_01
case_images: Triphasic abdominal computed tomography scan findings: The axial view revealed multiple tumor mass lesions in both the lobes, with arterial phase hyperenhancement (a) and late phase hypodensity (b). The coronal view revealed tumor thrombi in the portal vein (c) and tumor thrombi in the hepatic vein (d). The coronal view revealed maximum size of these tumor mass lesions was about 10.9 cm at S5/S6 (d). The coronal view revealed multiple enlarged lymph nodes in the paracaval and para-aortic regions of the retroperitoneum (d).
case_images: CRIHEP2023-4797233.001.jpg
case_images: PMC10425252_01_CRIHEP2023-4797233.001.jpg
case_images: fig1
case_images: Triphasic abdominal computed tomography (CT) demonstrated multiple tumor masses in both lobes of the liver, exhibiting arterial phase hyperenhancement and hypodensity in the late phase (Figures 1(a) and 1(b)). The largest tumor was measured approximately 10.9 cm (Figure 1(d)). Tumor thrombi were identified in the portal vein (Figure 1(c)) and hepatic vein (Figure 1(d)). Furthermore, multiple enlarged lymph nodes were discovered in the paracaval and paraaortic regions of the retroperitoneum (Figure 1(d)).
case_images: Chest computed tomography (CT) scan revealed borderline enlarged mediastinal, both hilar and left supraclavicular lymph nodes.
case_images: CRIHEP2023-4797233.002.jpg
case_images: PMC10425252_01_CRIHEP2023-4797233.002.jpg
case_images: fig2
case_images: Chest CT revealed borderline enlargement of mediastinal, hilar, and left supraclavicular lymph nodes (Figure 2).
case_images: Pathological findings (original magnification, x400): Immunohistochemical staining revealed positive AE1/AE3 (a) and positive GPC-3 (b) expression in the tumor cells. Hematoxylin and eosin staining exhibited small nests of pleomorphic tumor cells within a dense lymphoid stroma (c). The majority of lymphocytes stained positive for CD3 (d), while scattered lymphocytes showed positive staining for CD20 (e). Epstein-Barr virus encoding region in situ hybridization (EBER) demonstrated positive signals (f).
case_images: CRIHEP2023-4797233.003.jpg
case_images: PMC10425252_01_CRIHEP2023-4797233.003.jpg
case_images: fig3
case_images: Liver biopsy confirmed the presence of tumor cells positive for AE1/AE3 (Figure 3(a)) and GPC-3 (Figure 3(b)) immunohistochemically. Notably, there was a dense lymphoid stroma (Figure 3(c)), and the majority of lymphocytes were positive for CD3 (Figures 3(d) and 3(e)). In addition, the tumor cells were positive for Epstein-Barr virus encoding region in situ hybridization (Figure 3(f)), indicating lymphocyte-rich hepatocellular carcinoma.