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case_images: Timeline and MRI examination. Yellow arrows indicate the changes in lesion size. (A) Timeline of initial diagnosis, anti-PD-1 immunotherapy, radiotherapy and follow-up. (B) MRI results (June 28, 2019) prior to therapy. (C) MRI results (September 4, 2019) following 3 cycles of anti PD-1 treatment. (D) MRI results (October 24, 2019) following anti-PD-1 immunotherapy in combination with radiotherapy. (E) MRI results (April 8, 2020) following anti-PD-1 immunotherapy maintenance therapy.
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case_images: Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) were performed for further diagnostic evaluation ( Figure 1B ), which supported a diagnosis of ICC. Following targeted radiotherapy, an MRI conducted on October 24, 2019, demonstrated a significant reduction in the size of the liver tumor without enhancement, measuring approximately 38mm x 22mm ( Figures 1C-E ). An illustrated timeline documenting the initial diagnosis, combined treatment, complete remission, and post-treatment follow-up is presented in  Figure 1A .
case_images: Changes of PET-CT images. (A-E) High metabolism in the left liver, retroperitoneum, left adrenal gland, and left supraclavicular lymphnode, 2019/07/06. (F-J) Hypermetabolism disappeared in the left liver, retroperitoneum, left adrenal gland, and left supraclavicular lymphnode, 2019/12/19.
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case_images: A positron emission tomography-CT (PET-CT) examination ( Figures 2A-E ) revealed a hypermetabolic lesion in the left lobe of the liver, as well as enlarged and hypermetabolic lymph nodes in the upper retroperitoneum and left supraclavicular area, along with a hypermetabolic left adrenal gland. A subsequent positron emission tomography/computed tomography (PET/CT) scan on December 19, 2019, revealed no hypermetabolism in the left liver lesion, retroperitoneal region, supraclavicular fossa, or left adrenal lesions, indicating no signs of disease progression in these areas ( Figures 2F-J ).
case_images: Hematoxylin-eosin HE staining and EBER, PD-L1 analysis of liver tumor tissues from the needle biopsy. (A) HE staining for EBER (200x). (B) EBER staining was positive in some areas, shown in red cicyle (200x). (C) EBER positive and negative comparison (50x). (D) HE staining for PD-L1. (E) Immunohistochemical staining for PD-L1 expression.
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case_images: Furthermore, EBER was detected in the nuclei of specific liver tumor cells within the local area ( Figures 3A-E ).