PMC8313913_01
(a) CT findings at the initial diagnosis. CT images from the patient's first visit to his previous hospital. (b) CT findings at six months after hepatectomy. Peritoneal dissemination appeared. (c) CT findings at seven months after resection of peritoneal dissemination. Recurrence of HCC appeared in liver segment 7. (d) CT findings at seven months after resection of peritoneal dissemination. Recurrence of peritoneal dissemination appeared.
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HCC (Fig. 1a). He underwent emergency transcatheter arterial embolization (TAE) and subsequently underwent partial resection of liver segments 5 and subsegmentectomy of liver segment 6. Six months after hepatectomy, the patient received emergency TAE again for peritoneal dissemination (Fig. 1b) at a nearby hospital and underwent omental nodule resection and partial descending colectomy. Seven months after the second surgery, computed tomography (CT) showed liver segment 7 recurrence of HCC with peritoneal dissemination (Fig. 1c, d).
Changes in lesions in the peritoneal dissemination and lung metastasis after sorafenib treatment. Tumor characteristics from the (a) horizontal, (b) frontal plane, and (c) chest CT before sorafenib treatment. CT findings after three months of sorafenib treatment. Peritoneal dissemination and lung metastasis had progressed. Tumor characteristics from the (d) horizontal, (e) frontal plane, and (f) chest CT.
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Solid Tumors (mRECIST) (Fig. 2). Sorafenib was judged to be ineffective, so regorafenib was started as second-line chemotherapy.
Changes in lesions in the peritoneal dissemination and lung metastasis after regorafenib treatment. Tumor characteristics from horizontal, frontal plane, and chest CT. CT findings (a) before regorafenib treatment, (b) after 1 month, (c) after 3 months, and (d) after 10 months of regorafenib treatment.
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Ten months of regorafenib resulted in partial response (PR) based on the mRECIST (Fig. 3).
Timeline of the therapeutic modalities and changes in levels of alpha-fetoprotein.
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The AFP levels decreased from a maximum of 47,050 ng/mL to 24.6 ng/mL, and the DCP levels decreased from a maximum of 56,171 mAU/mL to 38 mAU/mL (Fig. 4).
CT and PET/CT findings after 22 months of regorafenib treatment. CT showed (a) a contrast-enhanced nodule in the peritoneal dissemination and (b) a new lung metastasis. PET/CT showed (c) a hypermetabolic lesion in the peritoneal dissemination with an SUVmax of 5.6, (d) while that of the right lung metastasis was 2.4.
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Twenty-two months after regorafenib, CT showed a new lung metastasis and a contrast-enhanced nodule in the peritoneal dissemination that was 10 mm in size (Fig. 5a, b). Fluorodeoxyglucose-positron emission tomography (PET)/CT showed a hypermetabolic lesion in the peritoneal dissemination with a maximum standardized uptake value (SUVmax) of 5.6, while that of the right lung metastasis was 2.4 (Fig. 5c, d).
Histological findings from the peritoneal dissemination. (a) Hematoxylin and Eosin (H&E) staining (x100), (b) H&E staining (x400).
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The pathological result was metastasis of HCC (Fig. 6).
(a) CT findings at two months after resection of the peritoneal dissemination. Recurrence of HCC appeared in liver segment 3. (b) CT findings after RFA treatment.
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Two months after the third surgery, CT showed liver segment 3 recurrence of HCC (Fig. 7a) and no change in the size of the lung metastasis. The HCC was a single nodule <20 mm in size and was treated with radiofrequency ablation (RFA) (Fig. 7b).