Cerebral metastasis from hepatoid adenocarcinoma of the stomach

Figure 1 MR imaging revealing a spherical occupying lesion in the left posterior-temple lobe with a high intensity on T₂-weighted images and irregular contrast enhancement with a clear boundary and uneven signal in size of about 6. 0 cm × 4.8 cm × 4.0 cm after administration of gadolinium-diethylene triamino pentaacetic acid (Gd-DTPA). A: Coronal gradient-recalled echo; B: Cross-sectional T2WI; C: Cross-sectional contrast enhancement T1WI; D: Coronal T1WI-delayed scan 4 h after contrast media injected via veins.

Figure 2 Brain metastatic tumor showing the growth pattern of solid cell nests (HE stain). A: Polygonal tumor cells with abundant eosinophilic cytoplasm, rich blood vessels and clear boundary of tumor and brain parenchyma (× 100); B: Polygonal tumor cells showing epitheliod and abundant eosinophilic cytoplasm, rich chromatin nuclei with obvious nucleoli (× 200); C: Round nuclei with obvious nucleoli, rich blood vessels resembling sinusoid-like blood spaces in hepatocellular carcinoma (× 200); D: Tumor cells exhibiting radial pattern surrounding thin- walled vessels (× 200).

Figure 3 Immunoreactive characte-ristics of brain metastatic tumor (EnVision). A: Positively- stained cytokeratin AE1/AE3 (× 200); B: Positively-stained cytokeratin 8 (× 200); C: Positively-stained AFP (× 200); D: Negatively-stained Hep-Par-1 (× 200).

Figure 4 Histopathological features of primary gastric hepatoid adeno-carcinoma. A: Tumor located at submucosa and intramuscle showing the growth pattern of solid cell nests (× 40); B: Part of tumor grown in cords separated by sinusoid-like blood spaces (×200); C: Part of tumor grown in solid appearance showing polygonal epithelioid tumor cells with abundant eosinophilic cytoplasm, round nuclei with obvious nucleoli (× 200); D: Intralymph vascular tumor thrombosis in primary carcinoma (× 200).

Figure 5 Immunohistochemical characteristics of primary gastric hepatoid adenocarcinoma. A: Positively-stained cytokeratin AE1/AE3 (× 200); B: Positively-stained cytokeratin 8 (× 200); C: Positively-stained AFP (× 200); D: Negatively-stained Hep-Par-1 (× 200).

Figure 6 CT imaging features of liver metastatic tumor. A: CT scan revealing nodular or lump-like, high-density contrast mass in liver lobes during arterial phase; B: Uneven enhancement during portal venous phase.

Figure 7 Features of ultrasound examination before operation of the brain metastasis.