A Primary Malignant Rhabdoid Tumor in Adult Liver
A 50-year-old male had admitted for further evaluation of large hepatic mass. The hepatic mass was found accidently in ultrasonography. His major symptom was a 7-kg weight loss in one month. No gastrointestinal symptoms were present. He had no history of hypertension or diabetes. The serologic markers for hepatitis were negative. His mother had died due to cholangiocarcinoma. On physical examination of the patient, a spider angioma was detected. In the laboratory tests, aspartate aminotransferase/alanine aminotransferase/alkaline phosphatase were increased at 148/54/1,215 U/L, alpha-fetoprotein (AFP) 166 ng/mL, and carcinoembryonic antigen (CEA) 8.19 ng/mL, but cancer antigen 19-9 was in the normal range at 26.6 U/mL. Computerized tomography (CT) showed a very large multinodular hypoattenuating mass with rim enhancement in the whole left lobe and anterior segment of the right lobe (). Also the common hepatic lymph nodes were increased in size. There was no abnormality in each right of left kidney. On positron emission tomography-CT, a large hypermetabolic mass was seen, encompassing the whole left lobe and the anterior segment of the right lobe ().\nFor diagnostic confirmation, CT-guided needle biopsy was performed. The biopsy cores were composed of hypercellular areas alternating with necrosis and hemorrhage. The cellular lesion showed loosely cohesive tumor cell clusters separated by intermediate fibrous septa. The large round tumor cells showed abundant eosinophilic cytoplasm and eccentric vesicular nuclei with prominent nucleoli (). Abnormal mitoses were frequent. Mucicarmine staining was negative for abundant cytoplasm. The immunohistochemical stains showed diffuse cytoplasmic-positive staining for cytokeratin (CK) 19 and vimentin () and focal positivity for epithelial membrane antigen and CK7. The immunohistochemical stains for hepatocyte antigen, alpha-fetoprotein, CK20, CD34, CD117, actin, desmin, S100, and human melanoma black 45 (HMB45) showed no reaction in tumor cells. Also the tumor cells showed partial loss of positivity for integrase interactor-1 (INI-1) ().