Figure Legends
FIGURE 1. A, B: Histologic sections from the liver biopsy demonstrate a cellular proliferation of monomorphic spindle cells arranging in intersecting fascicles and admixed with a lymphocytic infiltrate (A: 20X, inset: 8X; B: 40X; hematoxylin & eosin). The spindle cells show elongated nuclei with inconspicuous nucleoli and abundant eosinophilic cytoplasm. They show diffuse and strong immunoreactivity for smooth muscle actin, patchy but strong reactivity for desmin (D), and strong, diffuse reactivity for h-caldesm (E). An EBER chromogenic in situ hybridization (CISH) is strongly positive in the lesional cells.
FIGURE 2. A, B: Sections from the liver biopsy demonstrate a cellular spindle cell proliferation forming short intersecting fascicles and admixed with an inflammatory infiltrate (A: 20X; B: 40X; hematoxylin & eosin). The spindle cells show elongated, slender nuclei and abundant eosinophilic cytoplasm. They are diffusely and strongly positive for smooth muscle actin (C) and desmin and show focal positivity to h-caldesmon. An EBER chromogenic in situ hybridization (CISH) is strongly positive in the lesional cells (D).​
FIGURE 3. Sections from liver biopsy including H&E image (A: 20X; B: 40X; hematoxylin & eosin) and EBER CISH (C, D). There are multiple fragments with cellular spindle cell neoplasm which stain strongly for smooth muscle actin and focally for desmin. (EBER CISH was not widely available in 2000, instead EBV immunohistochemistry (IHC) was routinely performed which was negative on this specimen. For the purposes of this study, we were able to perform EBER CISH on the original biopsy which was strongly and diffusely positive for EBER)
FIGURE 4. Case 1: CT demonstrating a two cm lesion in the right hepatic dome and one cm lesion in the right inferior hepatic lobe (top and bottom left). The same hepatic lesions demonstrating increased FDG avidity on PET (top and bottom right).