case_images: PMC5964563_01
case_images: Contrast enhanced computed tomography scan. The image demonstrates a large left hypoattenuating hepatic lobe mass measuring 7.8 x 7.8 cm.
case_images: CRIHEP2018-1089394.001.jpg
case_images: PMC5964563_01_CRIHEP2018-1089394.001.jpg
case_images: fig1
case_images: A contrast enhanced computed tomography scan (CT) showed a hypoattenuating 7.8 cm lobulated mass in the left hepatic lobe (Figure 1).
case_images: Histologic section of the liver mass. (a) Sections of the liver showing sheets of spindle cells with a whorled pattern in a collagen rich matrix (hematoxylin-eosin, 200x). (b) The neoplastic cells are positive for epithelial membrane antigen by immunohistochemistry (200x).
case_images: CRIHEP2018-1089394.002.jpg
case_images: PMC5964563_01_CRIHEP2018-1089394.002.jpg
case_images: fig2
case_images: Histologic sections of the mass showed sheets of spindle cells with mild cytologic atypia, arranged in fascicles and whorls with intervening bands of collagen (Figure 2(a)). On immunohistochemistry, the tumor cells were positive for epithelial membrane antigen (EMA) (Figure 2(b)), vimentin, focally positive for progesterone receptor (20%), and negative for cytokeratin, HepPar 1, S-100, CD34, CD117, factor-VIII, CD31, human melanoma black 45 (HMB-45), inhibin, TTF-1, estrogen receptor, and smooth muscle actin.
case_images: Immunohistochemistry with MIB-1. Approximately 3% of the neoplastic cells stain for MIB-1 by immunohistochemistry (400x).
case_images: CRIHEP2018-1089394.003.jpg
case_images: PMC5964563_01_CRIHEP2018-1089394.003.jpg
case_images: fig3
case_images: MIB-1 proliferative index was approximately 3% (Figure 3).
case_images: Magnetic resonance imaging of the brain mass. The image shows a small enhancing parasagittal mass.
case_images: CRIHEP2018-1089394.004.jpg
case_images: PMC5964563_01_CRIHEP2018-1089394.004.jpg
case_images: fig4
case_images: To identify the primary source of the meningioma, a magnetic resonance imaging of the CNS was performed, which revealed a 1.4 cm bifrontal parasagittal dural mass (Figure 4).