case_images: PMC9868471_01
case_images: Multiphase contrast-enhanced CT of the upper abdomen, axial view. (A) A noncontrast CT showed multiple low-density masses and nodular mixed-density shadows in the left lobe and part of the anterior right lobe of the liver (white arrow). (B) The arterial phase showed heterogeneous ring enhancement (white arrow). (C) The venous phase showed continuous enhancement (white arrow). (D-F) The left branch of the intrahepatic bile duct and its branches were dilated, and high-density nodular shadows were seen in the liver (black arrow).
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case_images: In addition, there were enlarged lymph nodes in the hepatic portal, portacaval space, and around the abdominal aorta ( Figure 1 ).
case_images: Hematoxylin and eosin (HE) staining of the liver biopsy sample shows osteoclast-like giant cells and neoplastic spindle-shaped cells. (A; hematoxylin and eosin, x40); higher magnification of the destroyed liver structure lined by osteoclast-like giant cells and neoplastic spindle-shaped cells (B; hematoxylin and eosin, x100).
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case_images: Histopathological analysis revealed that tumors were rich in osteoclast-like giant cells and neoplastic spindle-shaped cells ( Figures 2A, B ).
case_images: (A-C) Immunohistochemistry showed that CK (Pan), EMA, and Hepa were negative (hematoxylin and eosin, x40).
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case_images: Immunohistochemistry demonstrated CK8/18 positivity in the tumor (A) and CK8/18 negativity for osteoclasts (B) (hematoxylin and eosin, x40).
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case_images: CAM5.2, but positive for SMA, P53, Ki-67 (30%), ACT, CK8/18 ( Figures 4A, B ), and vimentin. PCR and Sanger sequencing: no H3F3A gene mutation was detected. Combined with histopathology and immunohistochemistry, the diagnosis of undifferentiated carcinoma with osteoclast-like giant cells of the liver was considered.