PMC8236259_01
The abdominal ultrasonography revealed an isoechoic mass (3.5cmx1.0 cm in size) in the posterior right lobe (A and B), and a hypoechoic strip-like area measuring 3.7 cm x 1.9 cm was noted in the retrohepatic segment of the inferior vena cava (tumor thrombosis suspected, (C and D).
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The abdominal ultrasonography revealed an isoechoic mass (3.5cmx1.0 cm in size) in the posterior right lobe (Figure 1A-B), and a hypoechoic strip-like area measuring 3.7 cm x 1.9 cm was noted in the retrohepatic segment of the inferior vena cava (tumor thrombosis suspected) (Figure 1C-D).
Contrast-enhanced computed tomography (CECT) scan showed that an irregular tumor mass located in segment V of the right lobe of the liver with renal vein and inferior vena cava involved. The tumor had enhancement in the arterial phase and was washed out in the venous phase. ((A) precontrast scan, (B) arterial phase, (C) portal phase, (D) delayed phase).
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The tumor had enhancement in the arterial phase and was washed out in the venous phase (Figure 2).
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) displayed enhancement in the arterial phase and a defect in the venous phase ((A) DWI, (B) T2WI, (C) T1WI, (D) arterial phase, (E) portal phase, (F) coronal portal phase T1WI).
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Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) displayed enhancement in the arterial phase and a defect in the venous phase (Figure 3).
Celiac arteriogram demonstrates the hypervascular mass but does not provide much assistance in determining the number and location of feeding vessels to the target (A). Subselective arteriogram with a microcatheter clearly demonstrates the suitable target vessels to treat this tumor (B-E). Celiac arteriogram shows no tumor staining after DEB-TACE treatment with CalliSpheres microsphere (F).
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After three cycles of DEB-TACE (Figure 4) from 9th September 2016 to 22nd August 2017 and combined with Huaier granule 20 g three times a day orally, the level of AFP had decreased from 8165.8ng/mL to within the normal range (1.7 ng/mL).
DCE-MRI displayed the intrahepatic tumor and RV-IVCTT were complete responses after three cycles of treatments. ((A) DWI, (B) T2WI, (C) T1WI, (D) arterial phase, (E) portal phase, (F) coronal portal phase T1WI).
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In April 2018, the level of AFP was still normal and the follow-up chest CT demonstrated that the lung metastases disappeared (Figure 6C-D) and the DCE-MRI displayed that the liver tumor and RV-IVCTT showed complete response (Figure 5) according to the modified Response Evaluation Criteria in Solid Tumors criteria.
CT images before and after treatment. On admission before treatment, pulmonary metastasis (red arrow) were seen in the posterior segment of lower lobes of the lungs (A and B). After three cycles of treatments, the pulmonary metastasis had disappeared completely (C and D).
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The chest CT scan showed multiple nodular lesions in both lungs (Figure 6A-B) and pulmonary metastasis was considered. In April 2018, the level of AFP was still normal and the follow-up chest CT demonstrated that the lung metastases disappeared (Figure 6C-D) and the DCE-MRI displayed that the liver tumor and RV-IVCTT showed complete response (Figure 5) according to the modified Response Evaluation Criteria in Solid Tumors criteria.