case_images: PMC9978950_01
case_images: Serial CT images showing the lung metastasis 3 months after RFA (a), 5 months after RFA (b), 8 months after RFA (c), 28 months after RFA (d), 39 months after RFA (e), and 41 months after RFA (f).
case_images: cro-2023-0016-0001-527229_f1.jpg
case_images: PMC9978950_01_cro-2023-0016-0001-527229_f1.jpg
case_images: F1
case_images: AFP rose to 3,308, with total WBC of 5.5 x 103/microL, absolute lymphocyte count of 3.2 x 103/microL, and a repeat CT reported multiple bilateral pulmonary nodules, which have markedly increased in size and number since 1 month ago (Fig. 1a). At that time, she had low energy, decreased appetite, and was mostly confined to the house, while her hemoglobin level already returned to her baseline (10.2 g/dL). AFP was 18, total WBC 5.9 x 103/microL, absolute lymphocyte count 3.4 x 103/microL, and hemoglobin 12 g/dL, and CT at that time showed significant decrease in size of the multiple lung nodules and the liver masses (Fig. 1b). Largest lung nodules measured 1.3 cm compared to 2.7 cm in diameter in the prior study (Fig. 1b). Repeat CT scan 8 months from RFA (Fig. 1c) and 14 months after RFA (data not shown) again showed further decrease in the size of the lung lesions. Twenty-eight months after RFA, AFP increased to 74, and CT showed tumor recurrence in segment 7 liver lesion, while the bilateral lung nodules remained stable as subcentimeter lesions (Fig. 1d). CT of the chest 39 months after initial RFA showed development of left pleural effusion (Fig. 1e). CT scan 41 months after initial RFA (Fig. 1f) showed tumor throughout the right pleural space, large right lower lobe necrotic tumor with active bleeding.