case_images: PMC11074433_01
case_images: Triple phase CT of the liver reveals a large liver mass (5.6x4.6 cm) in the hepatic segment 8/4a [large arrows in (A-D)], presented as an ill-defined hypodense area in the precontrast phase (A), heterogeneous peripheral enhancement in the arterial phase (B) with progressively centripetal enhancement in the portal (C) and 5-min delayed phases (D). It shows persisted central enhancement with peripheral washout sign on 5-min delayed phase (D). It adheres to the right hepatic vein (RHV, small arrow) and the middle hepatic vein (MHV, small arrow) without tumor thrombus. Several small lesions with the same appearance are scattered in both hepatic lobes (not shown).
case_images: fonc-14-1358804-g001.jpg
case_images: PMC11074433_01_fonc-14-1358804-g001.jpg
case_images: f1
case_images: There were also a few poorly defined heterogeneous hypodense nodules surrounding the mass with a size of up to 1.3 cm ( Figure 1 ).
case_images: (A) shows abundant intratumoural fibrous stroma in scirrhous HCC. (B) Shows hepatocellular differentiation (CEA canalicular pattern) with fibrotic to sclerotic stroma in the surroundings, consistent with the scirrhous variant of hepatocellular carcinoma.
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case_images: PMC11074433_01_fonc-14-1358804-g002.jpg
case_images: f2
case_images: A second biopsy was performed to confirm the diagnosis and showed fibrotic to sclerotic stroma ( Figure 2 ). These tumor cells demonstrated hepatocellular differentiation ( Figure 2 ) and strong staining with Hep Par 1, Arginase 1, CK7, and CK19, along with a canalicular pattern for CEA expression.
case_images: Timeline of the patient's clinical course with key events, complications, and treatment changes. HCC, hepatocellular carcinoma; irAE, immune-related adverse event; DEB-TACE, drug-eluting bead transarterial chemoembolization; Rt PVE, right portal vein embolization; PD, progression of disease; SD, stable disease; DM, diabetes mellitus.
case_images: fonc-14-1358804-g003.jpg
case_images: PMC11074433_01_fonc-14-1358804-g003.jpg
case_images: f3
case_images: She passed away 15 months after the initial diagnosis.  Figure 3  is a summary of the patient's clinical timeline.