Residency Program - Case of the Month

Clinical History

The patient was a 21-month-old, previously healthy girl who presented with abdominal distension, emesis, and irritability to an outside hospital. She was found to have a liver mass. A liver biopsy was performed under anesthesia during which she developed bronchospasm. She was then intubated on propofol for 48 hours, developed propofol infusion syndrome, and later succumbed to complications of propofol infusion syndrome. An autopsy was performed.

Gross Photographs

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Figure 1 Liver at Autopsy with large mass
Figure 2 Cut surfaces of liver mass

Additional Relevant Gross Findings

The lungs also contained several subpleural white nodules ranging from 2-3 mm on the left upper and right middle lobes.

Microscopic Description

The liver mass lacks normal liver lobular architecture and does not contain bile ducts. Thick bands of collagen run through the mass. Between the bands of collagen are small, immature hepatocytes. The hepatocytes have minimal pleomorphism and do not have a substantially increased N:C ratio. There are large areas of hemorrhage and necrosis. There are focal areas of osteoblastic cells with osteoid. The uninvolved liver is unremarkable.

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Figure 3 Liver mass, 2x objective
Figure 4 Liver mass, 20x objective
Figure 5 Different area of liver mass, 4x objective
Figure 6 Pleural lung nodule, 4x objective
Figure 7 Lung near pleural lung nodule, 10x objective
Figure 8 Liver mass, HepPar1 stain
Figure 9 Liver mass, Beta-catenin stain

What is the diagnosis of the Liver Mass?

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