case_images: PMC10771282_01
case_images: Preoperative imaging findings. (A,B) Abdominal computed tomography (CT) scans revealed a prominently sized mass with heterogeneous density located within the left hepatic lobe. In addition, intraabdominal bleeding (red arrow) was observed near the liver. The contrast-enhanced CT scan revealed heterogeneous enhancement within the lesion, which showed close adherence to the middle hepatic vein and the curvature of the stomach. (C) Angiography findings showed significant thickening and increased branching of the left hepatic artery, suggesting a robust blood supply to the tumor. (D,E) The hypointense signal observed on the MRI confirmed that the lesion was not consistent with a hepatocellular tumor. The white arrow indicated the rupture of the tumor. (F) 3D reconstruction model based on CT results. The purple area below the liver indicated blood accumulation. The yellow arrow indicated the tumor.
case_images: fsurg-10-1329535-g001.jpg
case_images: PMC10771282_01_fsurg-10-1329535-g001.jpg
case_images: F1
case_images: Abdominal enhanced computed tomography (CT) revealed that a 11 cm x 9 cm mass was in the left lobe and caudate lobe of the liver, with some components exhibiting fat density (Figure 1).
case_images: Intraoperative images. (A) Intraoperative exploration revealed a large mass (white arrow) in the left lobe of the liver. The hepatic parenchyma around the mass was normal, and the mass was severely attached to the stomach. (B) The rupture (white arrow) of the tumor was strongly adhered to the smaller curvature of the stomach. (C) There was noticeable hyperemia and edema of the hepatoduodenal ligament, together with obvious adhesions. The left hepatic artery was severed, and due to unclear hepatic portal structure, no further intrathecal separation of the left portal vein was performed. (D) Intraoperative ultrasound was used to determine tumor boundaries. (E) The hepatic parenchyma was transected along the middle hepatic vein. (F) Detachment of the left hepatic pedicle (white arrow). (G) The confluence of left and right hepatic veins (white arrow) was exposed. (H) The left hepatic vein (white arrow) was transected by ENDO-GIA. (I) Cross-sectional view of the liver after mass resection. The white arrow indicated the middle hepatic vein.
case_images: fsurg-10-1329535-g002.jpg
case_images: PMC10771282_01_fsurg-10-1329535-g002.jpg
case_images: F2
case_images: The patient underwent laparoscopic surgery on day 7 following interventional embolization (Figure 2).
case_images: Postoperative histopathological results. (A) The tumor measured approximately 11 cm in diameter, exhibited a brown hue, and presented a smooth surface. (B) There was obvious hemorrhage and necrotic tissue within the tumor. (C) The tumor contained numerous adipocytes and epithelioid cells (HE staining; magnification x 200). (D) Tumor cells were positive for HMB-45 (immunohistochemical staining, magnification x 100). (E,F) One year postoperative CT follow-up results. No tumor recurrence or metastasis was detected in the patient.
case_images: fsurg-10-1329535-g003.jpg
case_images: PMC10771282_01_fsurg-10-1329535-g003.jpg
case_images: F3
case_images: Histological examination showed that the tumor was composed of proliferating blood vessels, smooth muscle cells, and adipose tissue, and the resection margins of the mass were negative (Figure 3).