case_images: PMC11026608_01
case_images: Enhanced liver imagings at different time points. (A) The T2-phase, arterial phase, portal vein phase, and coronal image of the enhanced liver magnetic resonance imaging on May 26, 2020. It revealed a mass in the right hepatic lobe (red arrows); (B-E) The arterial phase, portal vein phase, equilibrium phase and coronal image of the enhanced liver computed tomography images; (B) No signs of tumor on October 21, 2021; (C) Diffuse recurrence in the liver on May 7, 2022; (D) After two cycles of retreatment of immunotherapy on July 21, 2022. Significant reduction of liver lesions; (E) CT indicated no enhancing tumor lesions in the liver on September 15, 2023.
case_images: fonc-14-1321195-g001.jpg
case_images: PMC11026608_01_fonc-14-1321195-g001.jpg
case_images: f1
case_images: Enhanced magnetic resonance imaging (MRI) unveiled a 6.5x3.0 cm tumor in the right hepatic lobe ( Figure 1A ). By October 21, 2021, contrast-enhanced CT scans exhibited no evidence of HCC recurrence and no metastasis lesions ( Figures 1B ,  2B ). Subsequently, on May 7, 2022, he was hospitalized due to HCC recurrence accompanied by pulmonary and adrenal metastases ( Figures 1C ,  2C ). Consequently, immunotherapy was discontinued. Concurrently, contrast-enhanced CT illustrated a noteworthy reduction in the intrahepatic, pulmonary, and adrenal lesions ( Figures 1D ,  2D ). CT on September 15, 2023, no enhancing tumor lesions in the liver, no pulmonary lesions, and significantly decreased adrenal lesions were observed ( Figures 1E ,  2E ). Currently, the abdominal discomfort has significantly relieved.
case_images: Abdominal and pulmonary computerized tomography imagings at different time points. (A) Base line on May 26, 2020; (B) No pulmonary and adrenal metastasis on October 21, 2021; (C) Pulmonary and adrenal metastasis on May 7, 2022 (red and yellow arrows); (D) Interstitial pneumoni on July 21, 2022; (E) No pulmonary lesions and significantly reduced adrenal lesions on September 15, 2023 (yellow arrows).
case_images: fonc-14-1321195-g002.jpg
case_images: PMC11026608_01_fonc-14-1321195-g002.jpg
case_images: f2
case_images: Abdominal and pulmonary computerized tomography imagings showed no metastasis lesions ( Figure 2A ). By October 21, 2021, contrast-enhanced CT scans exhibited no evidence of HCC recurrence and no metastasis lesions ( Figures 1B ,  2B ). Subsequently, on May 7, 2022, he was hospitalized due to HCC recurrence accompanied by pulmonary and adrenal metastases ( Figures 1C ,  2C ). CT revealed the presence of interstitial pneumonia ( Figure 2D ), leading to a grade 2 immune pneumonia diagnosis. Consequently, immunotherapy was discontinued. Concurrently, contrast-enhanced CT illustrated a noteworthy reduction in the intrahepatic, pulmonary, and adrenal lesions ( Figures 1D ,  2D ). CT on September 15, 2023, no enhancing tumor lesions in the liver, no pulmonary lesions, and significantly decreased adrenal lesions were observed ( Figures 1E ,  2E ). Currently, the abdominal discomfort has significantly relieved.
case_images: Changes of clinical indicators. AFP, alpha-fetoprotein; LDH, lactate dehydrogenase; ALP, alkaline phosphatase; GGT, gamma-glutamyltransferase.
case_images: fonc-14-1321195-g003.jpg
case_images: PMC11026608_01_fonc-14-1321195-g003.jpg
case_images: f3
case_images: Notably, the AFP, LDH, ALP, and GGT levels normalized ( Figure 3 ).
case_images: The timeline with therapy and disease status. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization; RFA, radiofrequency ablation.
case_images: fonc-14-1321195-g004.jpg
case_images: PMC11026608_01_fonc-14-1321195-g004.jpg
case_images: f4
case_images: The patient's course is shown in  Figure 4 .