PMC7098351_01
Coronal CT scan of the abdomen on admission (a), after TAE (b), and after hepatectomy (c).
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F1
Abdominal CT scan showed cirrhotic liver, splenomegaly, and multiple lesions (the biggest - 15 x 13 cm) in segments V and VI (Fig. 1a); no metastases were found on chest/abdominal-pelvic CT. During the hospital stay, the patient had tumor rupture that was treated with bland transarterial embolization (gelatin sponge administration) (Fig. 1b). In addition, due to tumor invasion to surrounding organs, enterotomy of approximately 10 cm was made in the colon, and cholecystectomy was performed (Fig. 1c).
Chest CT demonstrating a nodule in the superior lingular segment of the left upper lobe (a), a nodule near the left oblique fissure (b), a nodule in the right lower lobe before RFA (c), and an ablation zone after RFA (d).
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F2
TACE, chest CT revealed 2 nodules in the left lung (Fig. 2a, b), which were subsequently removed via thoracoscopic wedge resection. The pathology confirmed those nodules to be HCC metastases. Three months later, chest CT showed a solitary nodule in the right lung (Fig. 2c) that was treated with radiofrequency ablation (Fig. 2d).
a, b18F FDG-PET/CT shows increased uptake in the left hilar lymph region. c Chest CT scan after radiotherapy.
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F3
It revealed metastases in the left hilar lymph nodes (SUVmax - 7.25, diameter - 25 mm; Fig. 3a, b). Two months after the end of radiotherapy, CT scan showed no signs of metastases (Fig. 3c), and both AFP and PIVKA-II levels normalized (Fig. 4).