Presentation
Abdominal distension
Patient Data
A large mass with calcified foci and central necrosis occupies most of the right liver lobe and medial segments of the left liver lobe. The mass shows heterogeneous arterial hyper-enhancement and delayed washout. It encases the right and middle hepatic veins and compresses the inferior part of intrahepatic IVC. Several venovenous intrahepatic collaterals developed because of venous obstruction. A small focus of tumoral invasion is suspected within the right portal vein. The hepatic artery hypertrophies to supply the hypervascular mass. The mass compresses the pre-pyloric antrum and the duodenal bulb. A few pulmonary nodules are visible even in the abdominal window setting. The secreted contrast in renal pelvises is due to a previous study.
The brown arrows and the red arrows point to pulmonary metastases and venous collaterals, respectively. The orange shows the compressed duodenal bulb; the white depicts calcified focus. The black arrow shows a small tumoral extension in the right portal vein.
Case Discussion
Considering the patient age and characteristics of the mass, hepatoblastoma is the most likely diagnosis, which was confirmed on biopsy. Pulmonary metastases and large unresectable mass imply stage IVb.
The patient underwent chemotherapy with a significant mass reduction.