27904130 Visualization

A female Sex outpatient in her Date 50s Date had routinely visited Clinical_event our hospital Nonbiological_location because of liver Disease_disorder cirrhosis Disease_disorder resulting from hepatitis Disease_disorder B Disease_disorder virus Disease_disorder and biliary Disease_disorder duct Disease_disorder stones Disease_disorder .
At 65 Age years Age of Age age Age , she suffered from HCC Disease_disorder with BCLC Lab_value early Lab_value stage Lab_value A.
Her liver Diagnostic_procedure function Diagnostic_procedure was well Lab_value preserved Lab_value , and Child Diagnostic_procedure - Pugh Diagnostic_procedure score Diagnostic_procedure was A.
She underwent left Detailed_description lateral Detailed_description segmentectomy Therapeutic_procedure for HCC Disease_disorder , without other Therapeutic_procedure preoperative Therapeutic_procedure treatments Therapeutic_procedure .
Histopathological Diagnostic_procedure findings Diagnostic_procedure revealed bridging Detailed_description fibrosis Disease_disorder and pseudolobule Disease_disorder formation Disease_disorder .
Serum Biological_structure levels of alpha Diagnostic_procedure - fetoprotein Diagnostic_procedure ( AFP Diagnostic_procedure ) and protein Diagnostic_procedure induced Diagnostic_procedure by Diagnostic_procedure vitamin Diagnostic_procedure K Diagnostic_procedure absence Diagnostic_procedure - II Diagnostic_procedure normalized Lab_value after primary resection Coreference (Figure 1).
In imaging Diagnostic_procedure studies Diagnostic_procedure , no LN Biological_structure metastasis Sign_symptom was detected at the time of primary resection Coreference of HCC.
Two Date and Date a Date half Date years Date postoperatively, the patient’s AFP Diagnostic_procedure level Diagnostic_procedure increased Lab_value dramatically Lab_value to 780.2 Lab_value ng/ml Lab_value .
A lobular Shape lesion Sign_symptom with fine Detailed_description enhancement Detailed_description was detected by contrast Detailed_description - enhanced Detailed_description magnetic Diagnostic_procedure resonance Diagnostic_procedure imaging Diagnostic_procedure .
The tumor Coreference measured 27 Distance mm Distance in Distance diameter Distance and was located caudally Biological_structure on Biological_structure the Biological_structure left Biological_structure kidney Biological_structure .
In contrast Detailed_description - enhanced Detailed_description computed Diagnostic_procedure tomography Diagnostic_procedure , the tumor Coreference showed strong Detailed_description enhancement Sign_symptom in the arterial Biological_structure phase Biological_structure (Figure 2A, 2B) and a relatively Detailed_description low Detailed_description density Sign_symptom in the portal Biological_structure phase Biological_structure (Figure 2C, 2D).
These enhancement findings appeared consistent with a typical Detailed_description HCC Disease_disorder pattern.
Detailed imaging studies of both magnetic resonance imaging and computed tomography were performed in this case because a very rare metastatic LN initially seemed to be debatable and we needed to rule out exclusion diagnoses.
Three Diagnostic_procedure - dimensional Diagnostic_procedure imaging Diagnostic_procedure proved that the tumor Coreference was fed Biological_structure by Biological_structure a Biological_structure main Biological_structure vessel Biological_structure from Biological_structure the Biological_structure inferior Biological_structure mesenteric Biological_structure artery Biological_structure (red arrow) and by an accessory Biological_structure feeder Biological_structure from Biological_structure the Biological_structure superior Biological_structure mesenteric Biological_structure artery Biological_structure (Figure 3).
Fluorine-18- fluorodeoxyglucose Diagnostic_procedure positron Diagnostic_procedure emission Diagnostic_procedure tomography Diagnostic_procedure ( FDG Diagnostic_procedure - PET Diagnostic_procedure ) and positron Diagnostic_procedure emission Diagnostic_procedure tomography Diagnostic_procedure - computed Diagnostic_procedure tomography Diagnostic_procedure did not detect the tumor (Figure 4), although we thought positron emission tomography-computed tomography was helpful to identify other metastatic tumors.
Further imaging findings revealed no other intrahepatic Biological_structure or extrahepatic Biological_structure metastasis Sign_symptom .
Based on the tumor location, the clinical diagnosis was solitary Detailed_description metastasis Sign_symptom to a mesocolic Biological_structure LN Biological_structure or HCC Disease_disorder dissemination Detailed_description .
Determining the ideal therapeutic strategy for solitary but extrahepatic rare metastasis was difficult.
Although rapid growth was a critical concern in this case, the tumor Sign_symptom was solitary Detailed_description and not accompanied by other Detailed_description metastases Sign_symptom .
Considering both diagnostic and therapeutic viewpoints, we finally chose surgical Therapeutic_procedure resection Therapeutic_procedure in this case.
No disseminative Sign_symptom nodules Sign_symptom , lymphadenopathy Disease_disorder , or ascites Sign_symptom was observed during surgery Coreference .
The tumor Coreference was located in the mesocolon Biological_structure nearly at Biological_structure the Biological_structure wall Biological_structure of Biological_structure the Biological_structure descending Biological_structure colon Biological_structure , and partial resection Coreference of the descending Biological_structure colon Biological_structure with regional Biological_structure mesocolon Biological_structure was performed.
The patient’s postoperative Therapeutic_procedure course Therapeutic_procedure was uneventful Lab_value , and she was discharged Clinical_event on postoperative day Date 8 Date .
Serum Biological_structure levels of tumor Diagnostic_procedure marker Diagnostic_procedure decreased Lab_value immediately Lab_value after surgery Coreference (Figure 1).
Macroscopically Diagnostic_procedure , the mesocolic Coreference tumor Coreference was a solid Lab_value and elastic Lab_value mass with a smooth Texture surface Texture (Figure 5A).
A yellowish Color nodule Sign_symptom was encapsulated Detailed_description in Detailed_description the Detailed_description cut Detailed_description surface Detailed_description (Figure 5B).
The enlarged Detailed_description LN Detailed_description contained metastatic Detailed_description HCC Disease_disorder with a ductal Detailed_description structure Detailed_description (Figure 6A), and immunohistochemically Diagnostic_procedure , the tumor was positive Lab_value for AFP Diagnostic_procedure and negative Lab_value for CK-20, which was consistent with the pattern of primary Detailed_description HCC Disease_disorder (Figure 6B).
The histopathological diagnosis was metastatic Detailed_description HCC Disease_disorder to a mesocolic Biological_structure LN Biological_structure .
As of the writing of this report, the patient has remained free of recurrence Sign_symptom for 13 Date months Date after Date the second surgery, and has also been carefully followed Clinical_event up Clinical_event .
No adjuvant Medication therapies Medication have been performed.