case_images: PMC2634763_01
case_images: Several imaging features of the tumors that developed in our patient 13 years after SVR. (A): Enhanced computed tomography (CT) scans in the arterial phase at the time of admission. A huge enhanced liver tumor about 13 cm in greatest diameter in the left lobe and another tumor about 3 cm diameter in segment V could be observed. (B): An ultrasonogram (US) showing large tumors suggesting invasion of the portal vein and bile ducts. (C): Celiac angiography showing marked multiple tumors' staining in both lobes. These imaging features strongly indicate HCC.
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case_images: PMC2634763_01_1757-1626-2-18-1.jpg
case_images: F1
case_images: Enhanced CT and US revealed huge liver tumors about 13 cm in greatest diameter in the left lobe invading the bile ducts and another tumor about 3 cm diameter in segment V (Figs. 1A and 1B, respectively). Similarly, angiography revealed markedly hypervascular nodules in the same lesions, strongly indicating that these tumors were HCC (Fig. 1C).
case_images: Photomicrograph of the liver tumor. (A):Histopathological examination revealed that the tumor lesion was well-differentiated HCC (x100). (B): The non-neoplastic adjacent lesion showed only mild fibrosis development, which was not a feature of advanced liver cirrhosis (x100).
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case_images: F2
case_images: To confirm the characteristic features of the tumor, we performed liver biopsy and confirmed that this tumor was well-differentiated HCC (Fig. 2A). Only mild fibrosis development could be observed in the adjacent non-cancerous lesions (Fig. 2B).
case_images: Enhanced CT scans after the combination treatment with TAE and stereotactic radiosurgery. The tumor size and vascularity improved, along with the significant reduction of the tumor markers (AFP and PIVKA-II). The serum level of AFP and PIVKA-II decreased from 164.9 ng/ml and 3692 mAU/ml to 14.4 ng/ml and 32 mAU/ml, respectively.
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case_images: F3
case_images: CT scanning revealed a remission status of these tumors (Fig. 3), and he was discharged from our hospital to be followed up in the outpatient clinic.