case_images: PMC10666916_01
case_images: Magnetic resonance imaging (MRI) showed heterogeneous thickened of the gastric sinus wall (arrow) on T1WI (B), T2WI (A, H), and DEC-MRI (E); Multiple intrahepatic masses (triangles) demonstrated on T1WI (D), T2WI (A, G), and DEC-MRI (arteria phase, (C); portal venous phase, (F); delayed phase, (I). No apparent lesion was discovered in the uterus (J).
case_images: fonc-13-1227236-g001.jpg
case_images: PMC10666916_01_fonc-13-1227236-g001.jpg
case_images: f1
case_images: T1WI ( Figure 1B ), the isointense or hyperintense signal on T2WI ( Figures 1A, H ), and heterogeneous and mild enhancement on dynamic contrast-enhanced MRI (DEC-MRI) ( Figure 1E ). The gastric lumen was remarkably narrowed with slight blurring of the plasma membrane layer; Multiple intrahepatic masses demonstrated hypointense signal on T1WI ( Figure 1D ), the hyperintense signal on T2WI ( Figures 1A, G ) and ring-like enhancement on DEC-MRI without hepatospecific contrast agent ( Figure 1C : Hepatic Arterial Phase;  Figure 1F : Portal Venous Phase;  Figure 1I : Delayed Phase), which the larger mass (5.7x5.3 cm) located in the lower right posterior lobe ( Figures 1D, G ).Many enlarged lymph nodes were found in the hepatogastric space and mesenteric zone. In contrast, no apparent lesion was discovered in the pelvic region ( Figure 1J ). Figures 1-3 ). Following a multi-disciplinary approach, the ninth cycle of chemotherapy was modified to include oxaliplatin and capecitabine.
case_images: The MIP image (A) revealed intense uptake in the stomach (arrow) and liver (triangles). On axial views, remarkably ring-shaped high uptake was observed in the thickened gastric sinus wall [(B, E, H) arrow] and the left lobe of the liver [(C, F, I) triangle]. No significant FDG uptake was observed in the pelvic region (D, G, J).
case_images: fonc-13-1227236-g002.jpg
case_images: PMC10666916_01_fonc-13-1227236-g002.jpg
case_images: f2
case_images: The 18F-fludeoxyglucose (18F-FDG) PET/CT revealed intense uptake in the stomach and liver, and moderate to intense uptake in the lymph nodes of the hepatogastric space and hilar region ( Figure 2A ). On axial views, remarkably ring-shaped high uptake was observed in the thickened gastric sinus wall (SUVmax, 7.1;  Figures 2B, E, H ) and the left lobe of the liver (SUVmax, 27.1;  Figures 2C, F, I ). No obvious abnormal uptake lesion was investigated in the pelvic region ( Figures 2D, G, J ). Figures 1-3 ). Following a multi-disciplinary approach, the ninth cycle of chemotherapy was modified to include oxaliplatin and capecitabine.
case_images: The treatment process timeline (A) and beta-HCG value (B) within nine cycles of chemotherapy.
case_images: fonc-13-1227236-g003.jpg
case_images: PMC10666916_01_fonc-13-1227236-g003.jpg
case_images: f3
case_images: Figure 3 ). Further, in the fifth cycle of chemotherapy, we changed a new chemotherapy regimen (cisplatin, vincristine and bleomycin, PVB) to mitigate the risk of drug resistance. Despite these interventions, beta-HCG exhibited a sustained upward trend, peaking at 41170 mIU/ml in the final assessment ( Figure 3B ). Figures 1-3 ). Following a multi-disciplinary approach, the ninth cycle of chemotherapy was modified to include oxaliplatin and capecitabine. The results indicated a losing monocyte counts which may be related to the increased death of drug loaded macrophages depleting monocyte. To provide a clear overview of the treatment journey, we have summarized the entire process in a timeline ( Figure 3A ).