case_images: PMC10597686_01
case_images: The representative abdominal and chest enhanced computed tomography (CT) images before and after the surgery. (A) CT images before surgery performed on February 5, 2021; (B) CT images after surgery performed on February 24, 2021.
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case_images: Contrast-enhanced chest CT revealed no signs of metastasis before surgery ( Figures 1A ,  2A ). The CT examination on the fourth day after surgery revealed a partial absence of the liver, a slight roughness of the residual liver margin, a slightly reduced density of the adjacent liver parenchyma, and a small pleural effusion on both sides ( Figure 1B ).
case_images: The representative abdominal and chest enhanced CT images performed at different time of the treatments. (A) CT images before surgery performed on February 5, 2021; (B) CT images performed on May 5, 2021; (C) CT images performed on July 8, 2021; (D) CT images performed on September 28, 2021; (E) CT images performed on August 29, 2022. The black arrows point to the liver lesions. The white arrows point to lung lesions.
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case_images: Contrast-enhanced chest CT revealed no signs of metastasis before surgery ( Figures 1A ,  2A ). Unfortunately, enhanced CT performed in May 2021 confirmed a new mass with enhancement, sized 3.9 cm x 2.7 cm, at the edge of the residual liver with the appearance of scattered, multiple, sized 0.3 cm - 0.5 cm lesions in both lungs ( Figure 2B ). Nevertheless, in July 2021, the CT scan performed two months after the beginning of therapy showed multiple slight contrast enhancement masses and nodules in the residual liver, with a maximum of approximately 6.5 cm x 5.2 cm, and both the number and volume of lung lesions increased ( Figures 2C ). Figures 2D ) compared with images in July, 2021. Furthermore, there was a decrease in tumor markers; the qualitative value of PIVKA-II decreased from 64315 mAU/ml to 22 mAU/ml, and the qualitative value of AFP decreased from 50500 ng/ml to 57.1 ng/ml. In August 2022, the enhanced CT showed that there was only a slightly low-density shadow about 2.1 cm in diameter left in residue liver, without enhancement, the metastasis of both lungs basically disappeared ( Figure 2E ), and the tumor markers approached the normal value.
case_images: The schematic treatment timeline of the patient. PD, progression disease; PR, partial remission; CR, complete remission.
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case_images: The schematic treatment timeline is depicted in  Figure 3 .