PMC8559549_01
Pathological data. (A) Hepatic surgery specimens showed histological characteristic of hepatocellular carcinoma. (B) Liver puncture specimens showed no histological characteristic of malignancy. (hematoxylin-eosin stain; original magnification 40xand 200x).
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HCC with tumor thrombus in the vessel ( Figure 1A ). Hepatic arteriography was performed one month after surgery, and no tumor staining was observed in the liver. No clear evidence of malignant tumor was found ( Figure 1B ). AFP level in regular examinations has been consistently below the normal value (0-7 ng/mL). A PET-CT examination in August 2021 showed multiple nodules in the liver, decreased FDG metabolism indicating no active tumor in the liver, and no tumor metastasis in the whole body ( Supplementary Figure 1 ).
Representative upper abdominal imaging showing changes in the liver tumor throughout the treatment period and the patient's course of treatment. After intratumoral cryoablation combined with antiangiogenic therapy plus immune checkpoint inhibitors, the patient's liver tumor was necrotic, with no obvious tumor activity, and some tumor lesions disappeared and shrank, which were evaluated as a complete response according to mRECIST.
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A time course of the entire case is shown in  Figure 2 . August 26, 2019, the patient underwent routine follow-up with an enhanced magnetic resonance imaging (MRI) of the upper abdomen, which revealed multiple metastatic tumors in the liver, the larger ones were around 6.3 x 4.3 x 4.7 cm, with hepatic hilar lymph node metastasis, suggesting that the patient's Barcelona Clinic Liver Cancer (BCLC) stage was stage C ( Figure 2 ). At this time, the patient's alpha fetoprotein (AFP) was 6050 ng/mL.
Serum alpha fetoprotein levels throughout the treatment period (red dots indicate increased and green dots indicate normal levels).
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The patient came to our hospital in early September 2019, and at this time, the patient's alpha fetoprotein (AFP) level was 90421.42 ng/mL ( Figure 3 ).