PMC9752909_01
Contrast-enhanced computed tomography of the hepatic extra-gastrointestinal stromal tumor. (A) A 110 x 112 mm mass with solid and cystic components was observed in the right hepatic lobe, with an uneven enhancement in the arterial phase scan. (B) The hepatic mass was treated by argon-helium cryosurgery in July 2009, at which point the tumor was cystic and measured 98 x 110 mm.
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Dual-phase enhanced abdominal CT showed a 110 x 112 mm solid cystic lump in the right liver lobe, but no other abdominal mass ( Figure 1A ). The hepatic mass was treated by argon-helium cryosurgery in July 2009 ( Figure 1B ).
Histological and immunohistochemical analyses of the hepatic extra-gastrointestinal stromal tumor. (A1, A2) Microscopically, the tumor consisted of spindle cells with pleomorphic nuclei arranged into fascicles (hematoxylin-eosin stain; A1, x100 magnification; A2, x400 magnification). The patient's hepatic extra-gastrointestinal stromal tumor had the following immunohistochemical staining profile: (B1, B2) DOG1, (C1, C2) CD117+ (B1, C1, x100 magnification; B2, C2, x400 magnification).
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Immunohistochemical staining was positive for CD117 and DOG1( Figure 2 ), but negative for CD34, S-100, and alpha-smooth muscle actin (SMA).
Computed tomography images of the hepatic extra-gastrointestinal stromal tumor. (A) In August 2009, prior to imatinib mesylate administration (400 mg once daily), the tumor mass measured 92 x 110 mm. (B) In January 2011, routine computed tomography examination showed that the lesion in the right hepatic lobe had shrunk to 30 x 30 mm. (C) In July 2012, the lesion grew to 55 x 78 mm. (D) Pericardial effusion was observed in August 2014. (E) In September 2014, the lesion measured 110 x 150 mm. (F) Before the patient was switched to sunitinib malate therapy (50 mg once daily on a 4/2 schedule), the tumor mass measured 96 x 138 mm. (G) In March 2017, the tumor was 92 x 110 mm in size. (H) The final computed tomography examination in October 2019 showed that the tumor mass measured 110 x 190 mm.
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One month later, treatment with imatinib mesylate (400 mg once daily) was initiated, and the patient tolerated its adverse effects ( Figure 3A ). By January 2011, the tumor mass in the right lobe of the liver had shrunk to 30 x 30 mm, as demonstrated in a routine CT examination ( Figure 3B ). However, by July 2012, the mass had increased to 55 x 78 mm ( Figure 3C ), reaching a size of 110 x 150 mm by September 2014 ( Figure 3E ), when pericardial effusion also became visible ( Figure 3D ). After a month, the patient's tumor lesion shrank to 96 x 138 mm ( Figure 3F ). Following treatment, the lesion became stable and only cystic changes were observed during the 30-month follow-up period ( Figure 3G ). However, by October 2019, the mass had again increased to 110 x 190 mm ( Figure 3H ).
Timeline of patient's diagnosis, treatment, and response. Colored rectangles near the timeline represent individuals' sequential therapy durations: green, imatinib therapy; red, interventional therapy; and yellow, sunitinib therapy. Original magnification, x400. Dx, diagnosis.
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The timeline of the patient's diagnosis, treatment, and response is shown in  Figure 4 .