PMC6390208_01
Pathological findings: (a) biopsy liver lesion showing the proliferation of
polygonal epithelioid tumor cells with abundant vacuolated cytoplasm
(hematoxylin and eosin, 200x); (b) tumor cells showing intravascular
expansion, occlusion of larger vessels, and epithelioid cells arranged in
strands, cords, and nests (hematoxylin and eosin, 400x); (c) TFE3 showing a
nuclear reaction with a WWTR1-CAMTA1 fusion; liver lesion showing strong
immunoreactivity to CD31 ((d) inset 400x and (e) CD34 inset 400x); and (f) a
low proliferative activity ki-67 (10%).
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T1, hyperintense in T2, which restricted in the diffusion sequence and in the dynamic phase presented target enhancement, said lesions located in segments V and VI, the largest of up to 22 mm. The tumor markers, including Alpha-fetoprotein (AFP), human chorionic gonadotropin (GCh), carcinoembryonic antigen(CEA), prostatic specific antigen (PSA), CA 125, and CA19-9, were within normal limits; after these findings, ultrasound-guided biopsy of liver segment V lesion was performed (Figure 1).
68Ga-DOTA-E-[c(RGDfK)]2 PET/CT scan: (a) baseline PET/CT in maximum intensity
projection (MIP; upper) and PET/CT fusion axial slices (lower) demonstrate
normal biodistribution of the radiotracer and residual liver disease post
hepatectomy; (b) after 3 months, PET/CT showed new hepatic lesions and
progression of disease was documented; (c) after 6 months of the same
therapy, a new hepatic lesion was seen; (d) 4 months later, the same lesions
was seen and stable disease was documented; (e) 5 months after changing the
therapy, morphologic lesions decreased and also molecular uptake of lesions
and partial response was documented; (f) the last PET/CT showed a decrease
of the lesions with a little uptake.
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With the same treatment, after 8 months, the patient presented a clinical improvement on PET/CT (December 2017; Figure 2); the patient remained clinically asymptomatic.