PMC8018578_01
(A) Magnetic resonance post-contrast (gadolinium enhanced) axial MRI performed 6 months before surgery show low peripheral enhancement. (B) Axial MR T2 WI, performed 1 month before surgery, show slightly hyperintense lesions visible in the red circle referable to colangiocarcinoma recurrence, located at the hepatic hilum, quickly grow in size.
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F2
Later on, considering the tumor progression with emergence at the radiological CT scan of lung metastasis and a new liver recurrence (Figure 2A), the patient received systemic therapy with TKI Pan-FGFR Derazantinib with limited effect on tumor progression. In July 2019, the patient was referred to our center; a restaging contrast-enhanced magnetic resonance was performed, revealing the presence of 12 hepatic metastatic lesions, the biggest one measuring 49 x 27 mm located in segment 4 (Figure 2B) and in close contact with the right portal vein, hepatic artery, and biliary duct.
(A) The probes are positioned intraoperatively under ultrasound. (B) Contrast computer tomography scan performed after 10 days from the surgery revealing complete ipodensity of the treated area indicating full necrosis of the neoplasia induced by electrochemotherapy with bleomycine.
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F3
We positioned under US guidance five electrode needles [VG-12 (1.2 mm) + 4.0 cm, IGEA S.r.l., Carpi, Italy] at the cardinal points of the metastasis located on the IVs and other four electrode needles [VG-12 (1.2 mm) + 4.0 cm, IGEA S.r.l., Carpi, Italy], at the cardinal points of the metastasis located on the II-VIIIs (Figure 3A). Eleven days after surgery, the patient was restaged with an abdominal CT scan revealing complete necrosis of the lesion with the absence of intralesional enhancement (Figure 3B).
(A) Contrast computed tomography scan performed with contrast 6 months after surgery and (B) magnetic resonance scan performed with gadolinium contrast T1 WI 10 months after surgery show in both that the electrochemotherapy-treated neoplasia resulted permanently ipodense indicating the necrosis of the lesion.
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F4
In all the restaging CT scans performed, the liver metastasis treated with ECT appeared permanently hypodense, and no contrast enhancement was observed about the obtained necrosis (Figure 4A).