A case of malignant peripheral neurosyma in the liver

Patient female, 53 years old1 week ago no obvious causes of right upper abdominal pain, when inhaling obvious, accompanied by fever and chills, the highest body temperature of 38.6 degrees CNo nausea, vomiting and sclaboy yellowing, urine yellowing, accompanied by a decrease in appetite, the size of the general normal, weight, physical strength no significant changesHas a history of hepatitis B, cirrhosis for many years, has been the spleen artery intervention embolism treatment, denied high blood pressure, diabetes and coronary heart history, denied the history of drug allergy: T36.8C, P72/min, R17/min, Bp98/68mm-HgPatients Are clear, no yellowing of the skin sclune, shallow lymph nodes are not swollen, cardiopulmonary hearing is not obvious abnormalThe abdomen is soft, the whole abdomen is pain-free and reactive pain, the liver spleen is not touched under the ribs, the liver area is free of pain, the liver palm (-), the spider slug (-)Intestinal sound can, mobile turbid tone (-), double lower limb is not swollenlaboratory examination: hepatitis B surface antigen quantification 6.33IU/mL; hepatitis B surface antibody quantification 2.80mIU/mL; hepatitis B E antibody quantification 0.14s/co; hepatitis B core antibody quantification 9.91s/co, White blood cell count 5.04 x 109/L; neutral cell percentage 81.2%; hemoglobin assays 82g/L; red blood cell ratio 24.6%; platelet count 79 x 109/LAFP, CEA within normal rangeliver bile color over-show liver right leaf substantive occupancy, the nature of the to be determinedAbdominal CT scan (Figure 1 to 4): the right leaf of the liver can be seen huge clumpy low density stove, the boundary is not clear, the range is about 11.0 cm x 7.2 cm x 10.2 cm, the flat sweep density is uneven, the CT value is 29 to 54HUThe enhanced arterial period was not significant, the CT value was 32 to 59HU, the venous CT value was 37 to 81HU, and the delayed CT value was 30 to 82HUCT diagnosis: (1) liver malignancy; (2) cirrhosis of the liver, enlargement of the spleen and high pressure of the venousFigure 1CT flat sweep liver right leaf can be seen huge clumpy low density stove, boundary is not clear, its internal density is not uniform, the range is about 11.0 cm x 7.2 cm x 10.2 cm, CT value is 29 to 54HU; 37 to 81HU; Figure 4A, BADelayed CT value of 30 to 82HU, B Delayed period coronary surgery seen: liver right leaf VIII, part of the V segment visible size of about 11 cm x 8 cm lumps, surface break, border is unclear, soft, with the muscosa, the lump visible fish-like tumor tissue and dark red blood clot The liver can also see multiple cysts of varying sizes Pathological diagnosis: malignant peripheral neurosyma of the liver's right lobe (Figure 5), tumor tissue invasion of adjacent liver tissue with obvious necrosis 5 Pathology: Tumor cell morphology, shuttle, oval and round, dense arrangement, cell boundaries unclear, visible nuclear division (HE x 100) immunohistchemistry: VIM (-), S-100 (plus), Ki67 (30% plus), P53 (-- ) , ATP (-), Hepatocyte (-), CK18 (-), CD34 (-), Actin (-), HMB45 (-), Melan-A (-), CEA (-), EMA (-), CK19 (-), PCK (-), DES (-), CD99 (-), Inhibin (-), Bcl-2 (-) discussed malignant peripheral peripheral sheath tumor (MPNST) from the peripheral neuroblastation and peripheral vascular malignancies, in 1993 WHO officially malignant neuroscarma (malignant sephora), neurogenerative sarcoma and neurofibromatosar, such as MPNST MPNST has a tendency to multi-differentiate toward sephora, Sewan's cells, and cells around the nerves Tumor cells are polymorphic and contain fibroblasts, Sewan's cells, epithelial cells, transparent cells and obvious intermorphic polymorphic cells, which are rare in heterogeneous interstitial cells and epithelial cells MPNST can be associated with neighboring neck, limbs, peritoneal, isolation and internal larger nerve stem, although MPNST can occur in various parts, but most often tired of sciatic nerves, Chen Feiyu and other found occurring areas are mostly spinal nerve roots or nerve dry, such as sciatic nerve, secondary nerve Combined with literature review, MPNST in different parts has a certain commonality, most of them larger, often accompanied by necrosis CT often manifests itself as a lump with a clearer boundary, etc or low density, and enhanced scanning necrosis lesions is a persistent low density Coleman et al believe that necrosis suggests a malignant possibility of lesions, indicating poor prognosis Liu Shien et al found that the average tumor diameter was 8.3 cm in 12 pathologically confirmed multi-site MPNST studies CT-enhanced scanning is unevenly enhanced, the actual part is patchy, mesh-like reinforcement, and the low density part is not continuously strengthened MPNST, which occurs in the liver, is extremely rare and diagnosis requires pathology In this case, the lesions are large, the boundary part is not clear, the flat sweep density is uneven, the multi-period enhancement is persistent uneven patch-like reinforcement, the internal low density lesions are not obvious, and the other parts of the literature reported MPNST similar but because the lesions are rare, this case needs to be identified with the following lesions: (1) primary hepatocellular liver cancer Although the patient sits on the background of hepatitis B and cirrhosis, AFP and CEA are normal, and the strengthening does not meet the characteristics of "early inando" of hepatocellular carcinoma; After enhancement, it can be sustained reinforcement, but the boundary of this case is clearer than bile duct cell carcinoma, there is no obvious dilation and invasion of the bile duct around the tumor; Its internal density is uneven, prone to necrosis and bleeding, enhanced after the strengthening of MPNST is obvious, strengthening characteristics are different, some cases from the edge to the center of continuous reinforcement