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case_images: Abdominal magnetic resonance imaging (MRI) showed a mass with the largest diameter measuring up to 11.0*9.5 cm in size in segments 7 and 8 in the right lobe of liver before surgical resection (A and B). Post-operative pathology revealed moderate differentiation and vascular cancer embolus (C and D).
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case_images: Enhanced abdominal magnetic resonance imaging (MRI) revealed a mass with the largest diameter measuring up to 11.0*9.5cm in size in segments 7 and 8 within the right lobe of the liver (Figure 1A and B). The incisal edge was negative and did not invade the hepatic capsule (Figure 1C and D). Enhanced abdominal computerized tomography (CT) scan showed a heterogeneous irregular mass measuring up to 2.3*2.2cm with arterial phase enhancement and venous phase washout in the left lobe of liver (Supplementary Figure S1).
case_images: Chest computerized tomography (CT) scans showing the course of lung metastases. (A and B) Baseline tumor situation of the targets at the start of sorafenib systemic treatment. (C and D) Progressive disease upon treatment with sorafenib. (E and F) Partial response (PR) in lung metastases after treatment with regorafenib for 3 months. (G and H) Marked tumor progression in the lung metastases. (I and J) Complete response (CR) in target lesions of lungs after treatment with sintilimab for five cycles.
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case_images: Chest CT scan revealed that multiple pulmonary nodules on both sides of the lung which were diagnosed as lung metastases, the largest up to 8-mm in diameter (Figure 2A and B). On June 12, 2019, restaging chest CT scan showed partial response (PR) in lung metastases (Figure 2E and F). Despite good tolerability of regorafenib, repeat MRI scans of both chest and abdominal on December 3, 2019 revealed obvious tumor progression in liver and lung (Figures 2G and H and 3E and F). After five cycles of sintilimab injection, a follow-up abdominal MRI scan showed complete response (CR) in target lesions of liver without any tumor activity, as assessed by mRECIST (Figure 3G and H), while chest CT scan revealed CR in target lesions of lung, as evaluated by RECIST v 1.1 (Figure 2I and J).
case_images: Abdominal CT and MRI scans showed the course of hepatocellular cancer in the liver. (A-D) Two masses in both sides of liver. (E and F) Marked tumor progression in the liver. (G and H) Complete response (CR) in target lesions of liver.
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case_images: On December 24, 2018, enhanced abdominal CT scan showed two lesions with the largest diameter greater than 3 cm in both sides of the liver (Figure 3A-D). Despite good tolerability of regorafenib, repeat MRI scans of both chest and abdominal on December 3, 2019 revealed obvious tumor progression in liver and lung (Figures 2G and H and 3E and F). After five cycles of sintilimab injection, a follow-up abdominal MRI scan showed complete response (CR) in target lesions of liver without any tumor activity, as assessed by mRECIST (Figure 3G and H), while chest CT scan revealed CR in target lesions of lung, as evaluated by RECIST v 1.1 (Figure 2I and J).
case_images: Local and systemic treatment methods (C) and tumor volume changes (A and B), summary diameter of target lesions according to RECIST v.1.1.
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case_images: Figure 4 showed local and systemic treatment and a summary diameter of target lesions according to RECIST v 1.1 or mRECIST criteria.