PMC8273654_01
Examination before treatment including dermatological inspection (A, B), head CT (C, D), chest CT (E, F) and pathological assessment (G).
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Mild edema was observed around both eyes, as shown in  Figures 1A, B . Liver, kidney and blood coagulation functions were all normal ( Figures 1C, D ). Cysts may have been present in the left lobe of the liver and in the right kidney ( Figures 1E, F ). Table 1 ), which were pathologically confirmed as AS ( Figure 1G ). The other indicators of routine blood tests are presented in  Table 1 .
Effect of anlotinib on scalp and facial lesion changes over a course of 10 months treatment. (A-J) left side lateral view and right side frontal view, (K-L) superior views.
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The clinical examinations showed that the scalp and facial lesions were gradually controlled, after an initial increase during the 1st month as shown in  Figure 2 . The current treatment efficacy was evaluated as a partial response (PR) according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1), since more than a 30% decrease in the sum of the longest diameters of the target lesions compared to the baseline sum of the longest diameters was detected.
(A, B) Examination of chest CT. (C) superior view, (D) lateral view and (E) posterior view of the scull during contrast MRI after 10 months treatment with anlotinib.
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CT revealed a low number of fiber proliferation foci scattered in the right lung; local thickening and adhesion of the bilateral pleura; right diaphragmatic surface swelling; aortic sclerosis; possible cysts in the left lobe of the liver and right kidney; gallbladder stones; bone hyperplasia of the thoracic vertebra and compressibility changes in the lumbar vertebra ( Figures 3A, B ). Contrast MRI of the head after diagnosis revealed multiple abnormal spots and patchy signals in the center of the bilateral semiovale and under the prefrontal parietal cortex. The soft tissue shadow at the top of the head was thickened and enhanced ( Figures 3C-E ). The diagnosis results were as follows: 1) Ischemia foci in the bilateral hemi oval center and frontal parietal lobe; 2) Demyelinating changes of white matter and brain atrophy; and 3) Soft tissue swelling at the top of the head with visible enhancement.