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Computed tomography of Case 1. (A, B) Scans at admission showed a large, space-occupying lesion in the right liver, obvious inhomogeneous enhancement in the arterial phase, relatively low density in the portal phase, and a large area of non-enhancement in the tumor. (C, D) Scans after conversion therapy and before resection showed extensive necrosis in the primary lesion, with no residual activity in the arteriovenous phase. Sections of hepatocellular carcinoma tumor from Case 1 after conversion therapy and resection. (E, F) Visible are necrotic lesions (downward arrows), hyperplasia of surrounding fibrous tissue and lymphocyte infiltration (rightward arrow) and hemosiderin deposition (leftward arrow). Magnification, 40x.
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No tumor recurrence was detected during follow-up through July 5, 2022, based on computed tomography and AFP ( Supplemental Figure S1 ).
PMC9583878_02
Computed tomography of Case 1. (A, B) Scans at admission showed a large, space-occupying lesion in the right liver, obvious inhomogeneous enhancement in the arterial phase, relatively low density in the portal phase, and a large area of non-enhancement in the tumor. (C, D) Scans after conversion therapy and before resection showed extensive necrosis in the primary lesion, with no residual activity in the arteriovenous phase. Sections of hepatocellular carcinoma tumor from Case 1 after conversion therapy and resection. (E, F) Visible are necrotic lesions (downward arrows), hyperplasia of surrounding fibrous tissue and lymphocyte infiltration (rightward arrow) and hemosiderin deposition (leftward arrow). Magnification, 40x.
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No tumor recurrence was detected during follow-up through July 5, 2022, based on computed tomography and AFP ( Supplemental Figure S1 ).
Computed tomography and magnetic resonance imaging of Case 2. (A, B) Tomography scans at admission showed a large, space-occupying lesion in the right liver, obvious inhomogeneous enhancement in the arterial phase (A) and relatively low density in the portal phase (B). (C-F) T1-weighted magnetic resonance imaging after conversion therapy and before resection showed extensive tumor necrosis, but there was still a small active area around the tumor showing high signal intensity in the early arterial phase (C) and low signal intensity in the late arterial phase (D), portal vein phase (E) and hepatobiliary phase (F).
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Dynamic enhanced computed tomography revealed a lesion (11.4 x 8.9 x 10.0 cm) on the inferior segment of the right anterior lobe without macrovascular invasion or extrahepatic metastases, but with liver cirrhosis and splenomegaly with collateral circulation ( Figures 2A, B ). On December 1, 2021, dynamic enhanced magnetic resonance imaging showed that the tumor had shrunk substantially (9.5 x 7.9 x 8.7 cm), the original lesion showed extensive necrosis, and some active lesions were situated around the original one ( Figures 2C-F ).
Histopathology of tumor tissue in Case 2 after conversion therapy and resection. (A) Viable cancer cells were observed (inside the red box), as well as necrotic cells (outside the red box). (B) The primary lesion showed massive necrosis with lymphocyte infiltration, and scattered tumor cell nests surviving around the lesion (red box). Magnification, 40x. (C) Higher-magnification image of the red box in panel (B) shows some degenerated tumor cells and some giant tumor cells. Magnification, 100x.
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The lesion area also showed substantial fibrous hyperplasia with lymphocyte infiltration ( Figure 3 ).