PMC9366243_01
Timeline and enhanced computed tomography scan at the time of diagnosis. (A) Showing the course of initial diagnosis, medication, and surgery. (B) Showing a large mass in segment 4 of the liver invading the middle hepatic vein. (C) Showing the mass in segment 4 of the liver invading the umbilical portion of the left portal vein. (D) Showing the mass adjacent to the main trunk of the right portal vein.
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The portal vein phase indicated that the tumor had invaded the middle hepatic vein and the umbilical portion of the left portal vein and was adjacent to the main trunk of the right portal vein (Figures 1B-D).
Cytologic examination and hematoxylin-eosin (HE) staining of liver tumor tissue from the needle biopsy and resected specimen. (A) Cytologic examination shows the presence of cancer cells (1000x). (B) HE staining (200x) of the liver tumor tissue from the needle biopsy. (C) HE staining (100x) shows only necrotic tissue in the resected tissue.
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AFP (-), Hepatocyte (-), VILLIN (+), MOC-31 (+), GATA-3(-), CD34 (-), Glypican-3 (-), and Ki-67 labelling index: 70% (Figure 2B). According to the American Joint Committee on Cancer staging system, 8th edition, the patient was diagnosed with stage IIIB (T2N1M0) iCCA. No viable tumor cell was detected in the resected specimen; only necrotic tissue was detected, indicating a pathologic complete response after systematic treatment (Figure 2C).
Enhanced computed tomography (CT) scans show that the cancer lesion changed over time. (A) CT results (2020.12.2) at the time of diagnosis. (B) CT results (2020.2.9) before the fourth cycle of treatment. (C) CT results (2020.4.23) before the radical surgery.
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After six cycles of treatment with nab-paclitaxel (200 mg, d1 and d8), S-1 (60 mg/m2, d1 to d14), and a PD-1 inhibitor (200 mg, q21 days), an enhanced CT scan showed that the longest diameter of the tumor shrank from 5.8 cm to 3.8 cm (Figures 3A-C).