case_images: PMC10753622_01
case_images: Preoperative images. (A, B) Triple phase CECT abdomen revealed a 5.8 x 6 x 6.2 cm heterogeneous hypodense lesion involving segments IVa and IVb of liver (white arrow) with nodular enhancement on arterial phase, early washout in venous and delayed phases. (C) 18-FDG PET-CT did not reveal any focus of increased FDG uptake. (D) DOTANOC PET CT showed a SSTR-expressing lesion in left lobe of liver (white arrow) with no disease elsewhere.
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case_images: PMC10753622_01_CCR3-12-e8382-g001.jpg
case_images: ccr38382-fig-0001
case_images: The lesion exhibited arterial phase enhancement, followed by washout in the venous and delayed phases, suggestive of hepatocellular carcinoma without any other lesions elsewhere (Figure 1A, B). Subsequent 18-Fluoro-deoxy Glucose (FDG) PET imaging did not reveal any areas of increased FDG uptake (Figure 1C). A whole-body DOTANOC PET-CT was conducted to search for a potential primary origin, but no other lesions were found apart from a 6.9 x 5.5 x 5.5 cm lesion in segments IVa and IVb of the liver (Figure 1D).
case_images: Intraoperative images. (A, B) 5 x 5 cm mass (white arrow) was found involving the left lobe of liver with normal right lobe (C, D) Left hepatectomy gross specimen showing a 6 x 6 cm growth (black marker on specimen) with variegated appearance with intact capsule.
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case_images: PMC10753622_01_CCR3-12-e8382-g002.jpg
case_images: ccr38382-fig-0002
case_images: Per-operatively a 6 x 6 cm mass was found involving the left lobe of liver (Figure 2A-D) with normal right lobe and multiple gallstones with normal gallbladder mucosa.
case_images: Postoperative images. (A) H&E stain, 40x view revealed invasive tumor arranged in nested insular pattern with abundant stroma. Cells show variable morphology with mild to moderate atypia, nuclear pleomorphism. (B, C) IHC showing Synaptophysin and chromogranin positivity (D) POD #9 CECT abdomen revealed large perihepatic collection (white star).
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case_images: PMC10753622_01_CCR3-12-e8382-g004.jpg
case_images: ccr38382-fig-0003
case_images: The immunohistochemistry confirmed synaptophysin and chromogranin positivity with negative Hep-par1 and CDX2 markers and Ki-67 of 8%-10% (Figure 3A-C). Ultrasound guided pigtail drainage did not help, even after up-sizing the same and CECT abdomen revealed large peri-hepatic collection with a controlled biliary fistula (Figure 3D).