Infiltrative hepatocellular carcinoma with portal vein tumor thrombosis
Known cirrhotic patient.
CT Abdomen and pelvis
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Cirrhotic liver with infiltrative hypervascular mass centered in the segments IVA and B. There is an arterial enhancement in the thrombosis within the portal vein of the medial and lateral segments of the left hepatic lobe. Small left lobe cyst.
Prominent collateral vessels are identified in the gastro-esophageal junction.
The solid abdominal organs and bowel loops are otherwise unremarkable. No evidence of free fluid or enlarged lymph nodes. No suspicious bony erosion is demonstrated.
The chest is unremarkable.
Conclusion: Portal vein tumor thrombus within the medial and lateral segments of the left lobe. Liver cirrhosis with collateral vessels in the gastro-esophageal junction. No metastatic disease.
This patient is known to the clinics and is in a palliative treatment. This is a poor prognosis case of HCC with portal vein invasion. In contrast to the nodular or massive subtype of HCC, infiltrative HCC isn't well defined. Malignant portal vein thrombosis is often seen with infiltrative HCC, as in this case.
The patient had a liver biopsy a few months prior to this study:
Microscopy: The core biopsies, cirrhotic liver and tumor, comprised of large polygonal hepatoid cells with variable nuclei and prominent nucleoli with scattered atypical mitoses, comprising trabecular plates greater than 3 cells in width. The cells show eosinophilic cell cytoplasm. There are frequent necrotic cells.
Conclusion: Core biopsy of liver showing cirrhotic liver containing moderately well-differentiated hepatocellular carcinoma.