PMC3226249_01
MRI of patient 1. (a) Before treatment. (b) After 9 months of treatment with sorafenib.
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MRI (Magnetic Resonance Imaging) showed (Figure 1(a)) a 120 mm hypervascular tumour of the right liver with a right portal branch tumoral thrombosis reaching the bifurcation. An MRI (Magnetic Resonance Imaging) (Figure 1(b)) and a new CT scan showed a 88 mm in diameter tumour (decrease in size of 27%) with a necrotic component.
Macroscopic aspect of patient 1's surgical specimen. Transverse section of the liver after fixation in 4% formaldehyde. The tumour has several nodules, with a focal capsule (*), and white areas corresponding to necrosis (arrows).
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The macroscopic (Figure 2) and microscopic (Figure 3) histopathological examination showed an HCC with a pseudoglandular aspect and necrosis (around 35% of the tumour).
Microscopic examination of patient 1's specimen at *10 magnification after hemalun eosin safran coloration. Bottom of the figure shows the HCC with a pseudoglandular aspect; top shows an eosinophilic irregular area corresponding to necrosis.
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The macroscopic (Figure 2) and microscopic (Figure 3) histopathological examination showed an HCC with a pseudoglandular aspect and necrosis (around 35% of the tumour).
PMC3226249_02
CT scan of patient 2. (a) CT scan before treatment. (b) Reassessment CT scan after 9 months of treatment with sorafenib.
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Pain in the right hypochondrial area revealed a 100 mm in diameter HCC taking up the whole right liver with a neoplastic thrombus of the right hepatic vein (Figure 4(a)). CT scan (Figure 4(b)) showed a 25% decrease of the tumour (75 mm); doppler ultrasound showed the thrombus to be necrotic. Considering this significant response to the sorafenib (TE3 response), a resection surgery was proposed 1 month afterwards.