case_images: PMC9816130_01
case_images: Imaging, laboratory tests, and pathology of the patient. (A-E) After systemic chemotherapy, the tumor size was reduced from 11 to 6 cm, and the patient was then treated with surgery. Postoperative imaging revealed no tumor lesions. (F) CA199 level decreased from 400 U/mL to 15 U/mL and remained normal thereafter. (G-I) The liver function damage could be controlled. AST, aspartate aminotransferase; DBIL, direct bilirubin; TBIL, total bilirubin. (J) H&E staining of the biopsy tissue (400x magnification) showed poorly differentiated cholangiocarcinoma. (K) Immunohistochemistry revealed strong CK19 expression, suggesting cholangiocarcinoma. (L) Macroscopic findings of the resected tumor (size: 7 x 7 x 6 cm). (M) H&E staining of the resected tissue (400x magnification) suggested poorly differentiated cholangiocarcinoma and pathological necrosis of the tumor. No microvascular invasion was observed.
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case_images: B). Contrast-enhanced abdominal magnetic resonance imaging (MRI) revealed a 110 x 108-mm lesion in the liver with enlarged hilar lymph nodes ( Figure 1A ). Chest computed tomography and emission computed tomography did not reveal significant tumor metastasis. Before initiating treatment, the patient's CA199 level was >400 U/mL ( Figure 1F ). Needle biopsy revealed a heterotypic cell mass (hematoxylin and eosin [H&E] staining, 400x magnification), which was strongly positive for cytokeratin (CK)19 on immunohistochemistry ( Figures 1J, K ). After each cycle there was a noticeable reduction in the tumor size ( Figures 1A-D ). After the fifth cycle of treatment, contrast-enhanced MRI showed little enhancement and few enlarged lymph nodes ( Figures 1B-D ). CA199 level reduced significantly after each treatment and remained normal at the end of chemotherapy ( Figure 1F ). Moreover, no fever, rash, myelosuppression, or other side effects were observed other than moderate liver damage ( Figures 1G-I ). The patient underwent surgical resection in May 2022, and during surgery, the tumor (approximately 7 x 7 x 6 cm) was found in the right lobe of the liver ( Figure 1L ). The examination also showed pathological complete necrosis of the tumor, and no lymph node metastasis or microvascular invasion was observed ( Figure 1M ). Follow-up MRI (before the next cycle of systemic therapy) performed 1 month after surgery revealed no recurrence ( Figure 1E ).