PMC8565924_01
Monitoring CTC count to track HCC progression after liver transplantation. (A) Electronic colonoscopy of the cecum and rectum in April 2018. Images revealed a spherical subpedicle polyp of about 0.6cm x 0.8cm in size in the cecum, with a smooth surface; and 8cm away from the anus, there are 2 polyps in the rectum, with the larger size of 2.0cm x 1.6cm. (B) Pathological biopsy observed under a microscope in August 2020. Images revealed under the light microscope, part of the epithelium showed mild to moderate atypical hyperplasia, with increased cell levels, but no clear malignant changes were seen. (C) Changes in circulating tumor cell (CTC) counts (number/mL) after metastasis. The summarizes results of CTC analysis in the present case from April 2018 to October 2020. The specimen showed the counts (number/mL) of CK+ CTCs changed from April 2018 to November 2018 obviously and then the counts (number/mL) of CSV+ CTCs also showed variations from May 2019 to October 2020. (D) Representative immunofluorescent images of CTCs obtained separately after blood analysis of the present case on May 9, 2018, August 6, 2020, and October 30, 2020, using Cellab Thomas I system (LABVIV, Shenzhen). CTCs were defined as captured cells that were cytokeratin positive (CK+) or vimentin +, CD45-, and DAPI+. The cytokeratin positive (CK+) or vimentin + were stained as red color; CD45+ was stained as green color and DAPI+ was stained as blue color. (E) Treatment timeline of patient from December 2016 to October 2020.
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However, a spherical polyp measuring 0.6x0.8 cm in size was observed in the cecum, and the surface was smooth ( Figure 1A ). The larger polyp measured 2.0 x1.6 cm in size, and its surface was rough and erosive ( Figure 1A ), which was confirmed by the pathological images ( Figure S1 ). Under light microscopy, some epithelia showed mild to moderate atypical hyperplasia with increased cellular levels, but no definite malignant changes were observed ( Figure 1B ). Moreover, changes in CTC counts (number/mL) provided evidence that the appearance and increased number were associated with recurrence or metastasis during monitoring ( Figure 1C ). CTCs were found to be DAPI positive, CD45 negative, vimentin positive, or DAPI positive and CK positive, with different nuclear morphologies from leukocytes. ( Figure 1D ). The timeline of the patient treatment showcased the complete date and progression from the episode of care ( Figure 1E ).