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. 2021 Jun;11(6):2521–2540. doi: 10.21037/qims-20-685

Figure 7.

Figure 7

A hypervascular poorly differentiated hepatocellular carcinoma (HCC) lesion (maximum diameter, 23 mm) in segment VII was found in a 76-year-old female patient with chronic hepatitis C. (A) Axial T1WI images on a plain scan show homogeneous hypointensity in the tumor, with a regular oval shape and distinct margin. The pre-contrast ratio was 0.62. (B) On the arterial phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (EOB-MRI) (25 seconds), the lesion is shown as a hyperintensity compared with the adjacent liver parenchyma. (C) On the portal phase (70 seconds) of EOB-MRI, the lesion is shown as a hypointensity compared with the adjacent liver parenchyma. (D) Twenty minutes after EOB agent injection, the lesion shows as a homogeneous hypointensity (arrow) on the hepatobiliary phase. The post-contrast ratio was 0.47, and the EOB enhancement ratio was 0.75. (E) In the grayscale ultrasound (US), the targeted lesion appears as a well-defined, homogeneous, hyperechoic lesion. (F) Using low mechanical index contrast imaging, the arterial phase Sonazoid contrast-enhanced ultrasound (SCEUS) shows hypervascularity. (G) During the portal phase, the lesion shows hypovascularity (typical washout). (H) The post-vascular phase image shows a significant hypoechoic lesion. (I) After switching to high mechanical index contrast imaging, the post-vascular phase image shows extremely significant hypoechoicity. (J) Hematoxylin-eosin staining reveals a large, bizarre-shaped nucleus, with hypercellularity and an increased nuclear cytoplasmic ratio. (K) Silver staining shows that reticular fibers disappeared. (L) Positive immunoreactivity in sinusoidal capillarization, showing a diffuse cluster of differentiation 34 expressions. (M) Cytokeratin 7 staining shows no expression in tumor areas, resulting in no ductular reaction. The arrows seen in (A,B,C,D) and the arrowheads seen in (E,F,G,H,I) indicate the margin of the lesion. The black bar length in the lower side of (M) represents 100 microns (µm) as a magnification reference for (J,K,L,M). All the above histopathological findings were compatible with poorly differentiated HCC. (D,E,F,I) are quoted from (26).