Small hepatocellular carcinoma with ring calcification: A case report and literature review

Figure 1 Findings of computed tomography. Upper left, plain abdominal computed tomography (CT) taken at the initial diagnosis revealed a 1-cm low-density lesion without calcification in liver segment 4 (white arrow). A small low-density area found in the left lateral section was a liver cyst (black arrow); upper right, plain abdominal CT taken 6 mo after the initial diagnosis revealed that the lesion had a ring calcification and an adjacent 1.8-cm lesion (white arrowhead); lower left and right, abdominal CT taken 6 mo after the initial diagnosis in the early phase (lower left) after a bolus administration of intravenous contrast material showed enhancement of the newly appeared lesion and the delayed phase (lower right) showed that it was hypoattenuated.

Figure 2 Macroscopic findings of the resected specimen, calcified and non-calcified lesions. A: Left, macroscopic examination showed a 10-mm tumor with ring calcification (arrow) and an 18-mm tumor (arrowhead) existing side-by-side and encapsulated within the same thick fibrous tissue; Right, a prepared specimen (loupe image, hematoxylin and eosin staining); B: Left, microscopic examination findings of the calcified lesion showed the poorly differentiated hepatocellular carcinoma (hematoxylin and eosin staining; original magnification, × 200); Right, microscopic examination findings of the non-calcified lesion showed moderately differentiated hepatocellular carcinoma (hematoxylin and eosin staining; original magnification, × 200).

Figure 3 Schematic image of the structure of the calcified lesion. Upper left, loupe image of the calcified lesion (hematoxylin and eosin staining; original magnification, × 5); Right, microscopic findings of the calcified lesion showed that necrotic area was extensively observed in the tumor (hematoxylin and eosin staining; original magnification, × 40); Lower left, schematic of the structure of the calcified lesion. A poorly differentiated tumor, in which spotty necrosis and hemorrhagic necrosis were extensively observed, was surrounded by a fibrous capsule. Calcification was identified between the tumor and the fibrous capsule (1: Poorly differentiated tumor; 2: Calcification; 3: Fibrous capsule).