Document resource
A 51-year-old man was admitted due to 4 month severe epigastric pain, with a history of untreated maternal–infant transmitted hepatitis B. Laboratory tests showed normal blood count and liver function, elevated alpha-fetoprotein (AFP) of 205 ng/mL, HBsAg (+), HBcAb (+), HBeAg (−), HBeAb (−) and an HBV-DNA level of 5143 IU/mL. Ultrasound and MRI revealed a large mass in the right upper abdomen, with suspicion of gastrointestinal stromal tumour (GIST) ( figure 1A). On referral to our hospital, enhanced abdominal CT showed a 10.2 cm × 8.8 cm mass with heterogeneous enhancement and an inconspicuous fast-in/fast-out pattern, suggesting origin from antrum, compression of right liver lobe (figure 1B,C) and blood supply from gastro-duodenal artery (figure 1D). Endoscopic ultrasonography (EUS) revealed an unclear boundary between the mass and the antrum, with smooth mucosa (figure 2). EUS-guided fine needle aspiration (EUS-FNA) was taken as PET-CT showed hypermetabolism, but the patient developed severe abdominal pain, hypotension and a decrease in haemoglobin immediately after operation, with CT angiography indicating contrast extravasation in the mass and haemoperitoneum (figure 3A). Massive intra-abdominal haemorrhage was suspected, and digital subtraction angiography (DSA) showed that the mass was mainly supplied by the hepatic arteries, with successful embolisation (figure 3B).