Tokyo Women's Medical University Hospital
Dr. Shun-ichi Ariizumi
DATE : 2009
The tumor in the posterior segment (S6) was shown as a minor, low-absorption region in the equilibrium phase of contrast computed tomography (CT).
A minor, low-signal region was present before contrast, but in the dynamic study it was shown with a signal approximately equal to that in the circumferential liver, and was indistinct.
However, it was recognized as a distinct, low-signal region 1 cm in diameter in the hepatobiliary phase.
Contrast CT arterial phase
Contrast CT equilibrium phase
20 s after administration
60 s after administration
120 s after administration
The S6 tumor was not clearly shown even by intraoperative ultrasonography, but part of it underwent colorization when an indocyanine green (ICG), infra-red camera system (Photo Dynamic Eye [PDE]) was used, and that part was excised.
The S6 tumor was of a small-nodular type, with indistinct margins, and was a yellow-brown region with coloration differing only slightly from the non-cancerous hepatic tissue.
(i) Loupe image of a hematoxylin-eosin-stained specimen of the indistinct-margin nodule, at the left cut surface where macroscopic findings were made. A region was shown in which the existence or otherwise of the portal region below the hepatic capsule was unclear. “a” indicates the portal region in the marginal part of early-stage HCC. (ii) The upper, left part is early-stage HCC, the lower, right part is non-cancerous hepatic tissue, and between those is the portal region. (iii) Observation with Victoria blue staining clearly showed portal region infiltration (arrow).
(ii) Magnification of “a”
(iii) Magnification of “a” (stained with Victoria blue)