case_images: PMC8733335_01
case_images: (A) Clinical course. (B) Carbohydrate antigen 19-9 (CA19-9) change curve.
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case_images: Urine examination revealed 375/mul white blood cells (WBCs) in the urine ( Figure 1 ). However, the patient's tumor indicators increased due to the discontinuation of lenvatinib and PD-1 antibody ( Figure 1 ). One month after the second operation, the patient's tumor indicators decreased and then increased again ( Figure 1 ). Urine examination revealed that WBCs were 2,818/mul ( Figure 1 ) and bacteria were 512/mul.
case_images: (A) October 22, 2019: magnetic resonance cholangiopancreatography showed the density of the soft tissue under the capsule of the right lobe of the liver. The possibility of metastasis was considered. (B) November 4, 2020: discovery of new lesions; tumor metastasis was considered (PET/CT showed nodular thickening of the capsule of the right posterior lobe of the liver, soft tissue density nodules in the fat space above the duodenum on the right side of pancreatic head in the abdominal cavity, and abnormal increase of glucose metabolism). Compared with the previous film, it was a new lesion. A high possibility of tumor metastasis was considered.
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case_images: f2
case_images: Imaging examinations also revealed new lesions located on the right posterior lobe of the liver and above the duodenum on the right side of the pancreatic head in the abdominal cavity ( Figure 2 ).
case_images: Histopathological findings. (A) was taken at 10x, and (B) was taken at 20x.
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case_images: f3
case_images: The result of the bladder biopsy indicated chronic inflammation of mucosal tissue, mucosal erosion in some areas, and proliferation of granulation tissues and fibroblasts ( Figure 3 ).