Fig. 1

Detection of multiple hepatocellular carcinomas (HCC) in the patient. Magnetic resonance imaging (MRI) reveals a 15 cm × 10 cm larger lesion in the left hepatic lobe and multiple smaller lesions in the right hepatic lobe, all less than 3 cm in diameter (a). Yellow arrows indicate multiple tumor foci of various sizes. MRI with contrast enhancement reveals tumor thrombosis involving the inferior vena cava (IVCTT), and the right portal vein branch (PVTT), indicated by the red arrows, respectively in b, suggesting intrahepatic and extrahepatic vascular spread of HCC. c shows representative photomicrographs of the multifocal invasive HCC that was profiled in this study. Of these foci, hematoxylin and eosin staining is shown for the large tumor, T1, its adjacent cirrhosis tissue (Non-Tumor), the tumor invading portal vein (PVTT), and peripheral hepatic vein (HVTT). Histologically, the HCC are of poor-to-moderate [16,17,18] differentiation with trabecular and solid patterns further evaluated by immunohistochemical (IHC) staining with Arginase-1 (Arg-1; Upper panel in d) and Hepatocyte Paraffin-1 (HepPar-1; Lower panel in d)