LAUSR

A 60-year-old woman with a 20 years history of hepatitis B presented with 2 weeks of dull pain in the right upper quadrant and intermittent nausea. On admission, blood tests demonstrated serum alpha-fetoprotein (8 μg/L), carbohydrate antigen 125 (10.3 U/mL), carbohydrate antigen 199 (9.9 U/mL), and liver function were within the normal range. Abdominal magnetic resonance imaging (MRI) showed a solitary lesion as a multi-layered target appearance resembling a “maze” in Segment VIII of the liver. On diffusion-weighted image and T2-weighted images, the mass surprisingly showed 6 layers with alternate high and low signals (Figure 1A-B). The lesion did not demonstrate as many layers on T1-weighted image, however, a target appearance was still recognizable (Figure 1C). On Gadolinium ethoxybenzyldiethy-lenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, the lesion showed progressive rim enhancement on the arterial and portal venous phase (Figure 1D-E) and appeared as a low signal target with a distinct hypointense core on the hepatobiliary phase (Figure 1F). The patient underwent laparoscopic lobectomy, and histopathology confirmed hepatic epithelioid hemangioendothelioma (HEHE). Microscopically, the tumor was composed of epithelioid and dendritic cells, which were positive for CD34, CD31, and CK-7 (Figure 2A-D).