PMC9727184_01
Oral examination revealed a mass on the upper left gingiva (A), and head neck imaging indicated that it was an osteolytic lesion and formed a soft tissue mass protruding to the subcutaneous maxillo-facial region and oral cavity (C-E); finally, it was diagnosed as maxillary metastasis from HCC after biopsy of the mass in the oral cavity (B, 200x). After comprehensive treatment of sintilimab plus bevacizumab biosimilar IBI305 plus radio-chemotherapy, the maxillary metastasis shrunk dramatically to nearly complete remission (F, G). A time course of the entire case is shown in (H).
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A 72-year-old Chinese woman was found to have a 6.5 cm x 6.3 cm, rounded, boundary-clear, heterogeneously arterial enhanced ( Supplementary Figure 1A ), and delayed washout ( Supplementary Figure 1B ) mass lesion in liver S2/3 via a computed tomography (CT) scan of the abdomen in June 2019. The immunohistochemical (IHC) analysis revealed the following ( Supplementary Figure 1C ): PD-L1 (-), CK19 (-), CK-p (weakly +), CK8 (weakly +), hepatocyte (focal +), Glypican-3 (+), Ki-67 (approximately 20% +), and positive CD34, indicating capillary-like hepatic sinusoid. After a year, the patient visited a dental clinic on 6 January 2022, complaining about a progressively enlarged, painful, bleeding, and hard soft tissue mass on the top left of the gingiva ( Figure 1A ). CT and MRI of the head and neck showed osteolytic destruction of left maxilla and a 2.8 cm x 2.2 cm enlarged soft tissue mass ( Figures 1C-E ). Pathological biopsy indicated poorly differentiated adenocarcinoma ( Figure 1B ), and results of IHC analysis were as follows ( Supplementary Figure 2 ): CK-p (+), CK8/18 (+), hepatocyte (focal +), vimentin (-), p63 (-), CK5/6 (-), CK-H (-), CK7 (-), Ki-67 (approximately 70% +), and PD-L1 (tumor proportion score < 1% +). On 15 March 2022, MRI showed that the maxillary metastasis had obviously shrunk and a nearly complete response (CR) was achieved according to the Response Evaluation Criteria in Solid Tumor version 1.1 ( Figures 1F, G ). A time course of the entire case is shown in  Figure 1H .
The dynamic changes of serous AFP level over time: AFP dropped to <400 ng/ml after surgical removal of an intrahepatic tumor in June 2019 and sintilimab-bevacizumab biosimilar IBI305-hfIMRT-oxaliplatin combination treatment in February 2022, and continued to decline gradually during the stage of maintenance treatment with sintilimab and bevacizumab biosimilar IBI305.
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Pathological biopsy indicated poorly differentiated adenocarcinoma ( Figure 1B ), and results of IHC analysis were as follows ( Supplementary Figure 2 ): CK-p (+), CK8/18 (+), hepatocyte (focal +), vimentin (-), p63 (-), CK5/6 (-), CK-H (-), CK7 (-), Ki-67 (approximately 70% +), and PD-L1 (tumor proportion score < 1% +). The changes in AFP are illustrated in  Figure 2 . She continued maintenance treatment with sintilimab (200 mg, every 21 days) and bevacizumab biosimilar IBI305 (600 mg, every 21 days) until May 2022, and AFP level gradually declined ( Figure 2 ).