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case_images: Magnetic resonance imaging for tumors. Magnetic resonance imaging (MRI) scans were performed at initial diagnosed (A), and before (B and C) and after (D) sorafenib therapy.
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case_images: A magnetic resonance imaging (MRI) scan revealed intrahepatic multiple nodules in the right liver (Figure 1A). However, the patient did not respond to the above treatment and disease progressed five months later (Figure 1B). After 1 month, the MRI scan showed a decrease in tumor size (Figure 1C). According to RECIST, the patient was considered to have a partial response (PR) to sorafenib (Figure 1D).
case_images: Pathological detection of surgical biopsy. Immunohistochemical staining of CK19 and HEP was performed on the surgical biopsy (A). In addition, the typical morphology of differentiated cholangiocarcinoma was evaluated by HE staining (B).
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case_images: The patients were diagnosed with cholangiocarcinoma with immunohistochemical staining positive expression of CK19 and negative for HEP (Figure 2A). Hematoxylin and eosin (H&E) staining confirmed a typical morphology of differentiated cholangiocarcinoma in the posterior portion of the right lobe, with invasion of the hepatic capsule and positive surgical margins (Figure 2B).
case_images: Integrative genomics viewer snapshot of FGFR2-BICC1. Alignment of NGS sequencing reads from the patient's tumor reveals a FGFR2-BICC1 rearrangement.
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case_images: The NGS analysis of the peripheral blood revealed a FGFR2-BICC1 rearrangement, as shown in Figure 3 (3D Medicines, Shanghai China).
case_images: Detection of FGFR2-BICC1 protein in cholangiocarcinoma. Immunohistochemical staining of FGFR2-BICC1 was performed on the surgical biopsy of cholangiocarcinoma.
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case_images: FGFR2-BICC1 protein was highly expressed in cholangiocarcinoma (Figure 4). For effective mutation, the patient underwent oral sorafenib treatment in November 2018.