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case_images: PET/CT revealed focal hypermetabolism in the lesions corresponding to the nodules observed in the CT scans before and after the combined treatment. The PET/CT scans conducted in January 5, 2021 (A) and September 23, 2021 (B).
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case_images: Additionally, multiple low-density liver lesions, enlarged lymph nodes adjacent to major blood vessels, and increased FDG metabolism in the hepatic hilar area, gallbladder vicinity, pancreatic head vicinity, and left iliac region were observed (Figure 1A). Increased FDG metabolism was observed in multiple lymphatic enlargements in various locations, including the portal area, around the gallbladder, around the head of the pancreas (SUVmax=25.9) and near the left common iliac blood vessel (SUVmax=2.9) (Figure 1A).  After two cycles of combined therapy, the patient achieved partial response (PR) based on CT evaluation, with a sharp decrease in total tumor diameter to 76.3 mm (Figure 4B1-B3, Table 1). Notably, no enlarged lymph nodes or abnormal elevation in FDG metabolism were observed in the hepatic portal area, peripancreatic head, and retroperitoneum (Figure 1B).
case_images: The results of hematoxylin-eosin staining on primary tumors. The liver mass aspiration biopsy revealed partial hepatocytes stasis, red-stained amorphous necrotic foci, and spindle cell hyperplasia fibrous tissue with lymphoid and plasma cell infiltration. The original magnification of the image is 100x. 100x(A) and 200x(B).
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case_images: Notably, endothelial or dendritic cells were found to possess enlarged nuclei (Figure 2).
case_images: The presents representative immunohistochemical staining images of tissues. The cells exhibited positivity for CD21 (A) and Ki-67 (B). The original magnification of the image is 100x.
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case_images: Immunohistochemistry analysis revealed the following results: CD23 (-), CK (pan) (+-), CD21 (+), CD30 (-), Ki-67 (80%+), EBER (-), CD34 (-), ALK (-), s100 (-), HMB45 (-), CD3 (-), CD20 (-), EMA (-) (Figure 3).
case_images: Timeline scheme depicted the major clinical events experienced by the patient since initial diagnosis.
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case_images: PR was observed for a duration of up to 30 months subsequent to the administration of sintilimab and anlotinib (Figure 5).