case_images: PMC5593392_01
case_images: Initial histology and CT findings.. Notes: (A) Microphotograph of adenocarcinoma, acinopapillary subtype. H&E staining, magnification x40. (B) Axial CT in lung window with solitary nodule in left upper lobe (arrow). (C) Axial CT of abdomen shows solitary liver metastasis (arrow) close to ablation zone in eighth segment. (D) Follow-up CT revealed multiple liver metastases (arrowheads).
case_images: ott-10-4347Fig1.jpg
case_images: PMC5593392_01_ott-10-4347Fig1.jpg
case_images: f1-ott-10-4347
case_images: Adenocarcinoma, acinopapillary subtype, g2, pT2N1Mo was verified (Figure 1A). Three months later, in May 2008, multi-slice computed tomography (MSCT) scan of the thorax and abdomen revealed one metastasis in the left lung (8 mm) and one in the liver (11 mm) in the eighth segment (Figure 1B and C) and suspected metastases in enlarged adrenal glands (the lesion in left 32 mm and in right 14 mm in diameter). In September 2008, a control CT scan of the thorax and abdomen registered further disease progression and the enlargement of liver metastases (Figure 1D).
case_images: Subsequent CT findings.. Notes: (A) Follow-up CT after 2 months' treatment shows only two small liver metastases (arrowheads). (B and C) Follow-up CTs of abdomen and thorax from March 2009 show no metastases. (D) Follow-up CT of abdomen from 2012 without liver metastases. (E and F) Follow-up CTs of thorax from 2010 and 2012 show no lung metastases.
case_images: ott-10-4347Fig2.jpg
case_images: PMC5593392_01_ott-10-4347Fig2.jpg
case_images: f2-ott-10-4347
case_images: In December 2008, MSCT of the thorax and abdomen verified excellent tumor response after 2 months of treatment with significant regression of liver metastases - from 13 down to only 2 (Figure 2A) - and a complete regression of lung and adrenal metastases. MSCT scan in March 2009 showed no metastasis (Figure 2B and C). Each consecutive evaluation, MSCT scans from January 2010 to February 2015, showed the maintenance of the complete response (Figure 2D-F).
case_images: CT finding of disease progression on erlotinib treatment.. Notes: (A) Enlarged lymph nodes of the liver hilum - about 5 cm in diameter (arrows). (B) Follow-up after six cycles of gemcitabine-cisplatin chemotherapy; nearly complete response (arrows). (C) Contrast-enhanced axial CT of abdomen shows small hypodenze node in the liver hilim is unchanged compared with previous CT; nearly complete response (arrows).
case_images: ott-10-4347Fig3.jpg
case_images: PMC5593392_01_ott-10-4347Fig3.jpg
case_images: f3-ott-10-4347
case_images: Positron emission tomography/computed tomography (PET/CT) showed increased fluorodeoxyglucose uptake in lymph nodes of the liver hilum, about 5 cm in diameter, with no other pathologic findings (Figure 3A). February 2016 with nearly complete response according to the RECIST 1.1 (Figure 3B) and ECOG PS of 0. Further on, gemcitabine monotherapy has been administered, with no AEs, which maintained nearly complete response (Figure 3C).