A 65-year-old male was admitted to the hospital with "pain in the middle and upper abdomen for more than 20 days, aggravated for 3 days". There was a history of choledochotomy and cholecystectomy 5 years ago. Physical examination: tenderness in the right upper abdomen (+), percussion pain in the liver area (+). Abdominal ultrasound: A solid mass was seen in the left lobe of the liver, with uneven echoes and unclear boundaries. Abdominal enhanced MRI: Heterogeneous and slightly longer T1 and T2 signal mass in the left lobe of the liver, about 9.3 cm ×8.2 cm in size, DWI showed high signal, and the enhanced scan showed progressive and obviously heterogeneous enhancement (Figure 1~4）。 Intraoperative exploration revealed atrophy of the left lobe of the liver with a mass, about 8 cm ×9 cm ×7 cm in size, and enlarged hilar lymph nodes. Left hemihepatectomy + radical lymph node dissection was performed. Macroscopically, the tumor was a single lesion, hard in texture, fish-like, and without envelope. Postoperative pathology: Invasive keratinized squamous cell carcinoma grade Ⅱ-Ⅲ, nerve invasion and intravascular tumor thrombus were seen in the focal area (Figure 5), hepatoduodenal ligament lymph nodes (1/5) showed cancer metastasis, and the resection margin was negative. Immunohistochemistry: CK5/6 (+), CK7 (focal area +), CK19 (+), P40 (+), P63 (+), Hepatocyte (-), AFP (-), CEA (focal area +), Ki67 (approximately 70% +). Postoperative gastrointestinal endoscopy showed no abnormalities. The patient was discharged on the 11th postoperative day. He died 2 months after surgery.
