PMC8564141_01
Pathology after hip replacement (H&E staining) showed heterogeneous epithelial cell infiltrating between trabeculae. The left was taken at x20, and the right was taken at x10.
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Pathological findings showed that local tissue of the femoral head was necrotic with a heterogeneous epithelial infiltration between the trabeculae, consistent with a metastatic adenocarcinoma ( Figure 1 ).
The baseline laboratory and imaging examinations for the patient. (A, B) Magnetic resonance imaging (MRI) of the upper abdomen. Tumor lesions are marked by red arrows. (C) Laboratory data on admission (outliers are highlighted in red). WBC, white blood cell count; N, neutrophil count; RBC, red blood cell count; Hb, hemoglobin; PLT, blood platelet count; AFP, alpha-fetoprotein; CEA, carcinoembryonic antigen; CA125, carbohydrate antigen 125; CA199, carbohydrate antigen 19-9; CA724, carbohydrate antigen 724; CA242, carbohydrate antigen 242; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; LDH, lactate dehydrogenase; T-Bil, total bilirubin; D-Bil, direct bilirubin; ChE, cholinesterase; TP, total protein; Alb, albumin; BUN, blood urea nitrogen; Cre, creatinine; Na, sodium; K, potassium; CL, chlorine; CRP, C-reactive protein; eGFR, glomerular filtration rate; HBsAg, hepatitis B surface antigen; HBsAb, hepatitis B surface antibody; HBeAg, hepatitis B e antigen; HBeAb, hepatitis B e antibody; HBcAg, hepatitis B core antigen; HBcAb, hepatitis B core antibody; HCV-Ag, hepatitis C virus antigen; HCV-Ab, hepatitis C virus antibody; PT, prothrombin time; INR, international normalized ratio; APTT, activated partial thromboplastin time; TT, thrombin time.
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Abdominal MRI showed multiple occupations in the liver and around the pancreatic tail ( Figure 2 ), while gynecological B-ultrasound and gastroenteroscopy revealed no abnormality.
The comparison of tumor indicators and CT images. (A) A timeline outlining the treatment course (lenvatinib 8 mg, orally, qd; and sintilimab 100 mg, intravenous glucose tolerance test, q21d) and changes of laboratory indicators including alpha-fetoprotein (AFP), neutrophils, lactate dehydrogenase (LDH), and eosinophils. (B) Imaging changes of the first four times of evaluation with tumor lesions marked by red arrows.
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Three weeks into the treatment, her AFP levels ( Figure 3A ) dropped dramatically, and tumor lesions ( Figure 3B ) shrank significantly.