PMC9755491_01
Unenhanced CT scan showed multiple intrahepatic lesions. (A) Contrast-enhanced CT scan showed heterogenous enhancement of the lesions with coalescence and target sign in the portal phase [(B,C), marked with arrow].
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F1
A contrast-enhanced CT scan showed multiple intrahepatic lesions with coalescence and target signs in the portal phase (Figure 1).
Multiple small lesions were detected in the lung (marked with arrows).
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F2
A chest CT scan revealed multiple small lesions in the lung (Figure 2). According to the radiological appearances,
Hematoxylin and eosin and immunohistochemical staining of the liver biopsy, which showed spindle-shaped tumor cells and epithelioid tumor cells [(A), hematoxylin and eosin, x200], and positive for CD 31, CD34, and ERG [(B-D), respectively, x200]. The index rate of Ki-67 was 20% [(E), x 200].
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F3
HEH was considered and a liver biopsy was then conducted. Histological examination showed spindle-shaped tumor cells and epithelioid tumor cells (Figure 3). Immunohistochemical staining showed that the tumor cells were positive for CD31, CD34, and ERG, with a Ki-67 index rate of 20% (Figure 3).
The intrahepatic lesions [(A,B), marked with white arrows] were stable after 2 years of treatment with anlotinib monotherapy [(C,D), marked with yellow arrows], while the lesions regressed or disappeared after 3 months of combined therapy with anlotinib and IFN-a 2b [(E,F), marked with red arrows].
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F4
The intrahepatic lesions regressed obviously at 3 months after the combined therapy and the size of the largest lesion decreased from 4.8 to 3 cm (Figure 4).