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case_images: The representative images of the computed tomographic (CT) scan of abdomen before (A, C) and after (B, D) olaparib treatment. (A) A hypovascular tumor over S6 of liver (asterisk); (B) regression of S6 tumor (asterisk) after olaparib treatment; (C) enlarged hepatic hilum lymph nodes (arrowhead); (D) regression of hepatic hilum lymph nodes after olaparib treatment.
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case_images: A CT scan of the abdomen revealed a large hypovascular tumor over S6 and enlarged hepatic hilar and retroperitoneal lymph nodes in August 2019 (Figure 1A and C). The patient received 300 mg of olaparib twice per day beginning in January 2020 (Figure 5), and a partial response was achieved in April 2020, with a CT of the abdomen revealing remarkable regression of the liver tumor (asterisk) and the hepatic hilar lymph nodes (arrowhead; Figure 1B and D).
case_images: Microscopic sections of CT-guided biopsy of liver tumor (A-D) and laparoscopic lymph node dissection (E-H). Hematoxylin and eosin stain revealed tumor cells were arranged in solid and trabecular pattern (magnification x200). The immunohistochemical studies identified positive of CK7 (B, F), glypican-3 (C, G) and arginase (D, H) staining.
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case_images: Microscopically tissue composed of neoplastic epithelial cells, bearing pleomorphic and hyperchromatic nuclei, and forming solid, trabecular and focal cribriform-like patterns with focal intervening sinusoidal-like spaces (Figure 2).
case_images: Sanger sequencing result of buffy coat on SeqStudio Genetic Analyzer. Target region: BRCA2 (Chr 13:32893243).
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case_images: As evident from the sanger sequencing, the BRCA2 mutation (c.97G>T) is not germline mutation as it is not present in the patient's peripheral blood mononuclear cell (PBMC) sample (Figure 3).
case_images: Copy number profile of the liver biopsy sample. Amplified regions are indicated by red dots; deleterious regions are indicated by blue dots.
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case_images: Eleven genes with heterozygous deletions (BAP1, CDKN2A, PTCH1, TSC1, BRCA2, RB1, RAD51, PALB2, TSC2, SMAD4, and STK11) were also identified (Figure 4).
case_images: Treatment timeline. Treatment course of combined hepatocellular cholangiocarcinoma from August 2019 to April 2020.
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case_images: The patient received 300 mg of olaparib twice per day beginning in January 2020 (Figure 5), and a partial response was achieved in April 2020, with a CT of the abdomen revealing remarkable regression of the liver tumor (asterisk) and the hepatic hilar lymph nodes (arrowhead; Figure 1B and D).