case_images: PMC9291079_01
case_images: CT and MRI scan results for the patient before treatment (A-E) and after treatment (F). (A) There was a diffuse, uneven thickening and abnormal enhancement in pyloric area which was approximately 22x24 mm in diameter under CT scan. (B-E) Cancerous thrombi were detected in hepatic portal vein (CT and MRI, respectively). (C and D) Cancerous thrombi were detected in left gastric vein (CT and MRI, respectively). (F) CT scan result after treatment.
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case_images: CT scan (Figure 1A). Cancerous thrombi were detected in the hepatic portal vein and left gastric vein by CT scan (Figure 1B and C). MRI scan also showed the same results in the left gastric vein and hepatic portal vein, respectively (Figure 1D and E). Compared to Figure 1B and C, Figure 1F represented the CT scan results for this patient finishing four months/four cycles of therapy after the initial AFP test which will be discussed in detail later. Immunohistochemically, the tumor cells were demonstrated to be positive for SALL4 (Figure 3E and F: gastric antrum and duodenum), AFP (Figure 3G and H: gastric antrum and duodenum) and hepatocyte (Supplementary Figure 1A and B: gastric antrum and duodenum). Whereas GPC3 was shown to be positive in the tumor from gastric antrum (Supplementary Figure 1C) but barely positive in the tumor from duodenum (Supplementary Figure D). On the contrary, caudal-type homeobox 2 (CDX2) which is thought to be a highly sensitive and specific marker for adenocarcinomas of intestinal origin was negative in the tumor from the gastric antrum (Supplementary Figure 1E) but positive in the tumor from the duodenum (Supplementary Figure 1F) which met the diagnostic criteria for HAC precisely.
case_images: PET-CT scan results for the patients before treatment. (A) There existed strengthened FDG activity at the gastric antrum and proximal duodenum (upper arrow: gastric antrum and proximal duodenum, lower arrow: tumor thrombus of the portal vein). (B-D) Transverse views of the PET-CT image indicated strengthened tracer uptake in gastric antrum (B), left gastric vein (C) and hepatic portal vein (D).
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case_images: In detail, maximum intensity projection (MIP)-FDG PET-CT image revealed an strengthened FDG activity at the gastric antrum and proximal duodenum (Figure 2A upper arrow: gastric antrum and proximal duodenum, lower arrow: tumor thrombus of the portal vein) and transverse views of the PET-CT image showed strengthened tracer uptake in gastric antrum (Figure 2B), left gastric vein (Figure 2C) and hepatic portal vein (Figure 2D) accompanying with standardized uptake values (SUV) as 4.1, 5.7, and 6.7, respectively. Supplementary Figure 2, the most profound pathway for these 10 genes was shown to be Notch signaling pathway which has been extensively studied and proved to play either an oncogenic or a tumor-suppressive role in different kinds of cancers. Supplementary Figure 3 demonstrated the timeline of events including diagnosis of chronic hepatitis B, date of raised AFP, treatment duration and dates of follow-up scans and tests.
case_images: EGD (A and B), HE (C and D) and IHC (E-H) results for the patient. (A and B) EGD showed a large irregular lump at the gastric antrum (A) and a deeply ulcerating mass at the duodenum bulb (B). (C and D) H&E staining results for the tumor residing in the gastric antrum and duodenum. (E and F) SALL4 staining results for gastric antrum (E) and duodenum (F). (G and H) AFP staining results for gastric antrum (G) and duodenum (H).
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case_images: Meanwhile, esophagogastroduodenoscopy (EGD) showed a large irregular lump at the gastric antrum (Figure 3A) and a deeply ulcerating mass at the duodenum bulb (Figure 3B). Figure 3C and D illustrated the hematoxylin and eosin (H&E) staining results for the tumor residing in gastric antrum and duodenum. Immunohistochemically, the tumor cells were demonstrated to be positive for SALL4 (Figure 3E and F: gastric antrum and duodenum), AFP (Figure 3G and H: gastric antrum and duodenum) and hepatocyte (Supplementary Figure 1A and B: gastric antrum and duodenum). Supplementary Figure 2, the most profound pathway for these 10 genes was shown to be Notch signaling pathway which has been extensively studied and proved to play either an oncogenic or a tumor-suppressive role in different kinds of cancers. Supplementary Figure 3 demonstrated the timeline of events including diagnosis of chronic hepatitis B, date of raised AFP, treatment duration and dates of follow-up scans and tests.