PMC9648660_01
Serial follow-up MR imaging (A-F) and contrast-enhanced CT scan (G-J) of the hepatic cystic lesion. The newly detected lesion (C, F) did not exist 12 months ago (A, D) and emerged as a small cystic lesion 7 months ago (B, E, arrow). Mild enhancement at the solid parts (arrowhead) was observed in contrast-enhanced CT scan.
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The MR scan ( Figures 1C, F  ) showed the mass as an isolated hepatic cystic lesion with solid component, with an approximate size of 9.6 cm x 10.7 cm x 9.2 cm. Historical MR studies indicated that the mass did not exist 12 months ago ( Figures 1A, D ) and emerged as a small cystic lesion 7 months ago ( Figures 1B, E ). Contrast-enhanced CT ( Figures 1G-J ) demonstrated mild enhancement at the solid parts of the mass.
18F-FDG PET/CT scan of the hepatic cystic mass. FDG-avid lesions (arrowhead) in MIP image (A) were demonstrated as moderate tracer uptakes in solid parts of the mass in axial images (B-G) and coronal images (H-J).
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Considering the patient's malignance history, the hepatic mass suggested metastasis. 18F-FDG PET/CT was performed for staging ( Figure 2 ).
Pathological images of the hepatic mass. Hematoxylin-eosin staining (A) and immunohistochemical staining of CK5/6 (B), P63 (C), and P40 (D) confirmed the mass as metastatic squamous cell carcinoma.
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The pathological study ( Figure 3 ) confirmed metastatic squamous cell carcinoma.
Bone scan, CT imaging, and MR imaging of bone metastases (arrowhead) after 6 months of treatment. Bone scan (A, B) showed no increased radioactive uptake, while CT imaging (C, D) demonstrated the metastases as osteolytic lesions with hyperintensity in MR spectral attenuated inversion recovery (SPAIR) sequence images (E, F).
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However, the tumor marker of CA724 ascended again during chemotherapy ( Supplementary Table S1 ), and the patient developed remote metastasis ( Figure 4 ).