case_images: PMC10051143_01
case_images: Abdominal CT - axial sections showing the hepatic lesions (red arrows).
  . (A) The lesions are spontaneously hypodense. (B) After injection of contrast product, the lesions are intensely enhancing in the arterial phase. (C) Contrast product wash out in the portal phase.
case_images: fsoa-09-836-g1.jpg
case_images: PMC10051143_01_fsoa-09-836-g1.jpg
case_images: F1
case_images: The lesions were spontaneously hypodense, intensely enhancing after injection of contrast product in the arterial phase with a wash out in the portal phase (Figure 1).
case_images: Hepatic MRI - axial sections.
  . (A & B) Hepatic lesions (red arrows) in hypersignal T2 and diffusion respectively. (C) Post-contrast images show enhancement in the arterial phase with a wash out in the portal and late phases.
case_images: fsoa-09-836-g2.jpg
case_images: PMC10051143_01_fsoa-09-836-g2.jpg
case_images: F2
case_images: The lesions were hyperintense on T2- and diffusion weighted MRI, enhancing in the arterial phase with a wash out in the portal and late phases (Figure 2).
case_images: Histological features of the hepatic VIPoma.
  . (A) Glandular architecture of the tumor (Hematoxylin-eosin x100). (B) Tumor cells are monotonous and display round nuclei and moderate amounts of eosinophilic cytoplasm. Nuclei show a characteristic stippled ("salt and pepper") chromatin pattern with inconspicuous nucleoli (Hematoxylin-eosin x400). (C) The tumor is diffusely and strongly positive for CD56 immunostaining (x400). (D) The proliferation marker Ki-67 highlights 2% of the neoplastic cells (arrow), consistent with a low proliferation index (x400).
case_images: fsoa-09-836-g3.jpg
case_images: PMC10051143_01_fsoa-09-836-g3.jpg
case_images: F3
case_images: A and CD56) (Figure 3). Anti-VIP antibodies were not however available.
case_images: Hepatic arteriogram with selective catheterization of the right hepatic artery from the femoral artery.
  . (A & B) A progressive blush of both lesions (red arrows) following the injection of contrast media. (C) Angiographic control showing total disappearance of the tumoral blush.
case_images: fsoa-09-836-g4.jpg
case_images: PMC10051143_01_fsoa-09-836-g4.jpg
case_images: F4
case_images: On the first session, the lesions in segment I and III were treated with excellent immediate results (Figure 4).
case_images: Follow-up abdominal CT taken one month after the second session of transarterial chemoembolization.
  . The CT showed a dense and homogeneous lipiodol deposition in the tumor on precontrast images (red arrow in [A]), without persistent arterial phase hyperenhasement (red arrow in [B]).
case_images: fsoa-09-836-g5.jpg
case_images: PMC10051143_01_fsoa-09-836-g5.jpg
case_images: F5
case_images: Abdominal CT scan performed after 4 weeks showed complete necrosis of the lesions (Figure 5).