case_images: PMC10586726_01
case_images: The details of the subsequent clinical course. Baseline: MRI examination revealed a lesion of approximately 1098cm in size in the right liver lobe segments S7 and S6, as well as a main portal vein thrombus.; 1 month: After three weeks of combined targeted therapy and immunotherapy, the patient's tumor was stable according to mRECIST; 2 months: After the patient received the second round of combination targeted and immunotherapy, the response was assessed as partial response (PR); 3 months: After 4 weeks of TACE treatment, the treatment response was reassessed and again determined to be PR; 4 months: After undergoing another round of combined targeted and immunotherapy, the response was assessed as a complete response (CR); 27 months and 34 months: The patient was treated with the original regimen for six months after surgery and has been without recurrence for over 27months and 34 months.
case_images: fonc-13-1199143-g001.jpg
case_images: PMC10586726_03_fonc-13-1199143-g001.jpg
case_images: f1
case_images: Four weeks later, the patient was evaluated as a PR ( Figure 1 , 3 months). CT examination showed that the main portal vein was occluded by an unclear thrombus ( Figure 1 , 4 months), which was believed to be a blood clot based on an MDT discussion. The patient was treated with the original regimen for six months after surgery and has been without recurrence for over 34 months ( Figure 1 , 34 months).
case_images: PMC10586726_02
case_images: The details of the subsequent clinical course. Baseline: MRI examination revealed a lesion of approximately 1098cm in size in the right liver lobe segments S7 and S6, as well as a main portal vein thrombus.; 1 month: After three weeks of combined targeted therapy and immunotherapy, the patient's tumor was stable according to mRECIST; 2 months: After the patient received the second round of combination targeted and immunotherapy, the response was assessed as partial response (PR); 3 months: After 4 weeks of TACE treatment, the treatment response was reassessed and again determined to be PR; 4 months: After undergoing another round of combined targeted and immunotherapy, the response was assessed as a complete response (CR); 27 months and 34 months: The patient was treated with the original regimen for six months after surgery and has been without recurrence for over 27months and 34 months.
case_images: fonc-13-1199143-g001.jpg
case_images: PMC10586726_03_fonc-13-1199143-g001.jpg
case_images: f1
case_images: Four weeks later, the patient was evaluated as a PR ( Figure 1 , 3 months). CT examination showed that the main portal vein was occluded by an unclear thrombus ( Figure 1 , 4 months), which was believed to be a blood clot based on an MDT discussion. The patient was treated with the original regimen for six months after surgery and has been without recurrence for over 34 months ( Figure 1 , 34 months).
case_images: Trends in PIVKA-II level from May 2020 to August 2022.
case_images: fonc-13-1199143-g002.jpg
case_images: PMC10586726_02_fonc-13-1199143-g002.jpg
case_images: f2
case_images: After three weeks, the patient's tumor was stable according to mRECIST ( Figure 1 , 1 month) and the trends in PIVKA-II level were shown in  Figure 2 . The patient was treated with the same regimen for one more cycle, and the response was evaluated as a partial response (PR) ( Figure 1 , 2 months).
case_images: PMC10586726_03
case_images: The details of the subsequent clinical course. Baseline: MRI examination revealed a lesion of approximately 1098cm in size in the right liver lobe segments S7 and S6, as well as a main portal vein thrombus.; 1 month: After three weeks of combined targeted therapy and immunotherapy, the patient's tumor was stable according to mRECIST; 2 months: After the patient received the second round of combination targeted and immunotherapy, the response was assessed as partial response (PR); 3 months: After 4 weeks of TACE treatment, the treatment response was reassessed and again determined to be PR; 4 months: After undergoing another round of combined targeted and immunotherapy, the response was assessed as a complete response (CR); 27 months and 34 months: The patient was treated with the original regimen for six months after surgery and has been without recurrence for over 27months and 34 months.
case_images: fonc-13-1199143-g001.jpg
case_images: PMC10586726_03_fonc-13-1199143-g001.jpg
case_images: f1
case_images: Four weeks later, the patient was evaluated as a PR ( Figure 1 , 3 months). CT examination showed that the main portal vein was occluded by an unclear thrombus ( Figure 1 , 4 months), which was believed to be a blood clot based on an MDT discussion. The patient was treated with the original regimen for six months after surgery and has been without recurrence for over 34 months ( Figure 1 , 34 months).
case_images: Surgical specimen and pathology. Surgically resected specimen (A, B); Pathology report showed hepatocellular carcinoma (C, D).
case_images: fonc-13-1199143-g003.jpg
case_images: PMC10586726_03_fonc-13-1199143-g003.jpg
case_images: f3
case_images: Four weeks later, the patient was evaluated as a PR ( Figure 1 , 3 months). On August 15, 2022, the patient underwent a right hepatectomy with portal vein thrombus removal and cholecystectomy under general anesthesia ( Figure 3A, B ). SP6) (Li: 20%) ( Figure 3C, D ). Supplementary immunohistochemistry experiments were performed, yielding further pathological insights.
case_images: The results of supplementary immunohistochemistry experiments. (A) the existence of moderately differentiated hepatocellular carcinoma (Grade 2) characterized by extensive necrosis within the liver tumor and bile duct resection specimen subsequent to liver cancer treatment (B) the presence of CD8 (partial lymphocytes+); (C) B-catenin (predominantly cytoplasmic+ in cancer cells; predominantly membranous+ in surrounding liver tissue); (D) a PD-L1 result of CPS=15.
case_images: fonc-13-1199143-g004.jpg
case_images: PMC10586726_03_fonc-13-1199143-g004.jpg
case_images: f4
case_images: CT examination showed that the main portal vein was occluded by an unclear thrombus ( Figure 1 , 4 months), which was believed to be a blood clot based on an MDT discussion. Immunohistochemical analysis demonstrates the presence of CD8 (partial lymphocytes+), and B-catenin (predominantly cytoplasmic+ in cancer cells; predominantly membranous+ in surrounding liver tissue), with a PD-L1 result of CPS=15 ( Figure 4 ).