case_images: PMC5677377_01
case_images: Abdominal CT images show that one of the lesions was located in the left lobe of the liver and the other was located in the para-aortic lymph node (A and B). In the venous phase, the mass was of low density and was irregular.. Abbreviation: CT, computed tomography.
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case_images: PMC5677377_01_ott-10-5237Fig1.jpg
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case_images: These masses were located in the left and right lobes of the liver and had a maximum volume of 8.1x7.8 cm, while the volume of the abdominal para-aortic lymph node was 5.4x4.1 cm (Figure 1).
case_images: Pathologic evidence of intrahepatic cholangiocarcinoma (A x100, x400) showing adenocarcinoma infiltration of normal liver tissue. Immunohistochemical staining showed that CK 18, CK 19, CK 7, and Cox-2 were positive, while CDX 2, CK 20, Glypican 3, and Hep-1 were negative, which support adenocarcinoma from the intrahepatic bile duct (B, CK 19; C, Hep-1; D, CK 18; E, CK 7; F, Cox-2; G, CK 20; H, Glypican 3; x100, x400).. Abbreviations: CK 18, Cytokeratin 18; CK 19, Cytokeratin 19; CK 7, Cytokeratin 7; Cox-2, cyclooxygenase-2; CDX 2, caudal type homeobox 2; CK 20, Cytokeratin 20; Hep-1, Hepatocyte Paraffin 1.
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case_images: PMC5677377_01_ott-10-5237Fig2.jpg
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case_images: He underwent a liver puncture, and the mass was histologically confirmed as ICC (Figure 2). The immunohistochemical analysis showed that the neoplastic cells were positive for CK 18, CK 19, CK 7, and Cox-2 and negative for CDX 2, CK 20, Glypican 3, and hepatocyte markers (Figure 2).
case_images: Confirmation of tumor shrinkage. A CT scan on August 5, 2015, revealed the tumor to be smaller after chemotherapy. (A), lesion located in the left lobe of the liver, (B) lesion located in the para-aortic lymph node.. Abbreviation: CT, computed tomography.
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case_images: This also met the RECIST (Response Evaluation Criteria in Solid Tumors) criteria for a partial response (PR) (Figure 3).
case_images: Tumor size before and after 1 month of treatment with apatinib.. Notes: After 4 months of treatment with a PD-1 inhibitor, the disease continued to progress on June 3, 2016 (A and B, before the treatment with apatinib). One month after the start of apatinib treatment, a CT scan suggested stable disease on July 16, 2016 (C and D, after 1 month of treatment with apatinib).. Abbreviations: CT, computed tomography; PD-1, programmed death-1.
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case_images: PMC5677377_01_ott-10-5237Fig4.jpg
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case_images: Dohme Corp, Kenilworth, NJ, USA), a programmed death-1 (PD-1) inhibitor. During 4 months of the treatment, an upper abdominal CT scan (June 3, 2016) revealed that the disease continued to progress (Figure 4A and B). A before the treatment with apatinib. Following 1 month of therapy, a CT scan suggested stable disease (SD) on July 16, 2016 (Figure 4C and D). After that, the patient stopped using apatinib, and a CT scan after 2 months suggested PD (Figure 5).
case_images: The tumor was larger after apatinib treatment was stopped, and a CT scan after 2 months suggested progressive disease (A and B, September 9, 2016).. Abbreviation: CT, computed tomography.
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case_images: A before the treatment with apatinib. Following 1 month of therapy, a CT scan suggested stable disease (SD) on July 16, 2016 (Figure 4C and D). After that, the patient stopped using apatinib, and a CT scan after 2 months suggested PD (Figure 5).
case_images: Stable disease after second round of apatinib use (A and B, May 11, 2017).
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case_images: The patient then began treatment with apatinib once again. At that time, an upper abdominal CT scan (May 11, 2017) obtained after 10 months of apatinib treatment suggested SD (Figure 6), and the progression-free survival was 8 months.
case_images: The various treatments the patient received as well as the duration of each treatment.. Abbreviation: CT, computed tomography.
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case_images: The only toxicity observed was mild hand-foot syndrome. The entire timeline of treatment is presented in Figure 7.