Image of the Month—Quiz Case

A 71-year-old Asian man with a history of cadaveric orthotopic liver transplant for hepatocellular carcinoma (HCC) in the background of hepatitis B cirrhosis 10 years earlier presented with a 6-month history of decreased appetite, decreased energy level, and slowly increasing α₁-fetoprotein level. The patient also reported a frequent urge to urinate, nocturia, and difficulty voiding his bladder. These symptoms were attributed to benign prostatic enlargement, and the patient underwent transurethral resection of the prostate by his local urologist. The patient developed abdominal pain, fever, and signs of septic shock postoperatively. A computed tomographic scan showed a large necrotic pelvic mass involving the prostate that extended to the sigmoid colon. Because a localized abscess was suspected, an image-guided drain was placed that returned necrotic tissue but no obvious purulence. After he recovered from the septic shock and his condition was stabilized in the intensive care unit, the patient was transferred to our institution for further treatment.