PMC8462656_01
Preoperative clinical parameters implied regression of a biopsy-proven HCC. (A) Initial MRI (top: postcontrast T1 image, bottom: diffusion-weighted image) showed a 2.3-cm tumor bearing the hallmark characteristics of HCC. (B) Postbiopsy MRI confirmed decreasing arterial enhancement (top: postcontrast T1 image) and decreased size (bottom: diffusion-weighted image) of the HCC lesion. (C) Serum AFP declined to within normal limits after the initial scan. AFP, alpha fetoprotein; HCC, hepatocellular carcinoma; MRI, magnetic resonance imaging.
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Magnetic resonance imaging (MRI), which showed no evidence of cirrhotic liver morphology or splenomegaly, confirmed a 2.3-cm segment 4 hepatic lesion exhibiting arterial enhancement, portal venous phase washout, and pseudocapsule; the lesion also exhibited restricted diffusion on diffusion-weighted MRI sequences (Fig 1A). HCC. He underwent a follow-up MRI approximately 9 weeks after the initial MRI, and this showed a decrease in size to 1.6 cm and a decrease in arterial enhancement of the biopsy-proven HCC (Fig 1B). During this evaluation, the patient's serum alpha fetoprotein level, which was initially elevated to 9.6 ng/mL (reference range: 0-7.8 ng/mL), declined to 5.4 ng/mL, and has since remained within the normal range (Fig 1C).
(A) H&E stain of biopsy tissue showing HCC with a prominent lymphocytic infiltrate. Scale bar is 200 mum. (B) IHC staining of biopsy tissue confirmed that the infiltrating lymphocytes were predominantly CD8+ (Leica [4B11]). Scale bars are 200 mum and 20 mum (inset). (C and D) There were also rare CD56+ (Leica [PA0191]) cells present in the biopsy specimen. Scale bars are (C) 200 mum and (D) 50 mum. (E and F) CD8 IHC staining of the resected liver segment showed a residual brisk CD8+ immune cell infiltrate into a 4-mm scar and no residual cancer cells. Asterisks denote the presumed border of the original tumor. Scale bars are (E) 2 mm and (F) 100 mum. HCC, hepatocellular carcinoma; H&E, hematoxylin and eosin; IHC, immunohistochemistry.
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T cells (1,084 per mm2) (Fig 2B) and relatively few CD56+ natural killer (NK) cells (Fig 2C). The resected liver segment contained a 4-mm scar that was devoid of cancer cells but which was notable for a substantial density of CD8+ T cells (1,678 per mm2) (Fig 2D).