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).