PMC2634763_01
Several imaging features of the tumors that developed in our patient 13 years after SVR. (A): Enhanced computed tomography (CT) scans in the arterial phase at the time of admission. A huge enhanced liver tumor about 13 cm in greatest diameter in the left lobe and another tumor about 3 cm diameter in segment V could be observed. (B): An ultrasonogram (US) showing large tumors suggesting invasion of the portal vein and bile ducts. (C): Celiac angiography showing marked multiple tumors' staining in both lobes. These imaging features strongly indicate HCC.
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F1
Enhanced CT and US revealed huge liver tumors about 13 cm in greatest diameter in the left lobe invading the bile ducts and another tumor about 3 cm diameter in segment V (Figs. 1A and 1B, respectively). Similarly, angiography revealed markedly hypervascular nodules in the same lesions, strongly indicating that these tumors were HCC (Fig. 1C).
Photomicrograph of the liver tumor. (A):Histopathological examination revealed that the tumor lesion was well-differentiated HCC (x100). (B): The non-neoplastic adjacent lesion showed only mild fibrosis development, which was not a feature of advanced liver cirrhosis (x100).
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F2
To confirm the characteristic features of the tumor, we performed liver biopsy and confirmed that this tumor was well-differentiated HCC (Fig. 2A). Only mild fibrosis development could be observed in the adjacent non-cancerous lesions (Fig. 2B).
Enhanced CT scans after the combination treatment with TAE and stereotactic radiosurgery. The tumor size and vascularity improved, along with the significant reduction of the tumor markers (AFP and PIVKA-II). The serum level of AFP and PIVKA-II decreased from 164.9 ng/ml and 3692 mAU/ml to 14.4 ng/ml and 32 mAU/ml, respectively.
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F3
CT scanning revealed a remission status of these tumors (Fig. 3), and he was discharged from our hospital to be followed up in the outpatient clinic.