PMC9403894_01
Contrast-enhanced magnetic resonance imaging (MRI) of the liver before TILA-TACE. Contrast-enhanced MRI of the liver showed at least six large masses in the liver, the largest one of which was approximately 14 cm in diameter. All of the masses demonstrated a slightly low mixed signal on T1WI (A) and a slightly high mixed signal on T2WI (B); after contrast, all these masses were clearly enhanced (C, D). In addition, a mass located in the tail of the pancreas that measured 3.6 cm in diameter was observed (arrow), with short T1 (E) and long T2 (F) signals on MRI, and the mass was evidently enhanced after contrast (G, H).
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Neuroendocrine tumors were first considered ( Figure 1 ).
Facial changes of the patient, including acrochordons and rhinophyma.
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Facial changes included acrochordons and rhinophyma ( Figure 2 ).
Contrast-enhanced MRI of the liver after the third TILA-TACE cycle showed that all of the masses demonstrated slightly low mixed signal on T1WI (A) and high mixed signal on T2WI (B). After contrast, most of the masses were almost necrosed (C, D).
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C-peptide, IGF-1, HbA1c, and glucose levels during treatment are shown in  Table 1 . Contrast-enhanced MRI of the liver performed after the third cycle of TILA-TACE showed that almost all of the large liver lesions had complete necrosis ( Figure 3 ).
Microscopic examination of the pancreatic lesion (6.5 x 5 cm in size) demonstrated the presence of spindle-shaped cells, abundant tumor cells with atypia, approximately four to five mitotic figures/10 HPFs, and local infarction, in accordance with the World Health Organization grade III. (A) HE staining (x100). (B) CD34 immunohistochemical stain (x200). (C) BCL2 immunohistochemical stain (x200). (D) STAT-6 immunohistochemical stain (x200).
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Immunohistochemistry findings revealed positive staining with antibodies against CD34, Bcl-2, STAT6, and CD31, and Ki-67 was 10% ( Figure 4 ).
Contrast-enhanced magnetic resonance imaging (MRI) of the thoracic spine. Contrast-enhanced MRI of the thoracic spine confirmed thoracic spine metastasis and one metastatic nodule projected into the spinal canal and compressed the spinal cord. (A) T1WI; (B) T2WI; (C) T1WI postcontrast.
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Contrast-enhanced MRI of the thoracic spine confirmed thoracic spine metastasis, and one metastatic nodule had projected into the spinal canal, compressing the spinal cord ( Figure 5 ).
Microscopic examination of the thoracic spine metastatic tumor with HE staining (x100).
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Histopathology also showed a spindle cell tumor ( Figure 6 ).