26523273 Visualization

A 36 Age - year Age - old Age female Sex presented Clinical_event at the emergency Nonbiological_location department Nonbiological_location with aggravating Detailed_description right Biological_structure upper Biological_structure abdominal Biological_structure pain Sign_symptom for 2 Duration hours Duration .
The patient was diagnosed hepatitis History B History virus History (HBV) History carrier History for History several History years History and non History -alcoholics.
No History other History specific History personal History and History familial History medical History history History was History noted History .
Initial blood Diagnostic_procedure pressure Diagnostic_procedure was 100/60 Lab_value mmHg Lab_value , pulse Diagnostic_procedure rate Diagnostic_procedure 70/min Lab_value , respiration Diagnostic_procedure rate Diagnostic_procedure 20/min Lab_value , body Diagnostic_procedure temperature Diagnostic_procedure 37.5℃ Lab_value .
The laboratory Diagnostic_procedure findings Diagnostic_procedure were white Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure 12,000/mm3 Lab_value ( poly Diagnostic_procedure : 70% Lab_value ), hemoglobin Diagnostic_procedure 12.8 Lab_value g/dL Lab_value , platelet Diagnostic_procedure 198,000/mm3 Lab_value , prothrombin Diagnostic_procedure time Diagnostic_procedure 14.3 Lab_value seconds Lab_value , international Diagnostic_procedure normalized Diagnostic_procedure ratio Diagnostic_procedure 1.11 Lab_value , aspartate Diagnostic_procedure aminotransferase Diagnostic_procedure 22 Lab_value IU/L Lab_value , alanine Diagnostic_procedure aminotransferase Diagnostic_procedure 12 Lab_value IU/L Lab_value , total Diagnostic_procedure bilirubin Diagnostic_procedure 0.5 Lab_value mg/dL Lab_value , alkaline Diagnostic_procedure phosphatase Diagnostic_procedure 134 Lab_value IU/L Lab_value , lactate Diagnostic_procedure dehydrogenase Diagnostic_procedure 295 Lab_value IU/L Lab_value , gamma Diagnostic_procedure - glutamyl Diagnostic_procedure transpeptidase Diagnostic_procedure 26 Lab_value IU/L Lab_value , protein/albumin Diagnostic_procedure 6.4/4.0 Lab_value g/dL Lab_value , uric Diagnostic_procedure acid Diagnostic_procedure 5.0 Lab_value mg/dL Lab_value , blood Diagnostic_procedure urea Diagnostic_procedure nitrogen/creatinine Diagnostic_procedure 16.6/0.7 Lab_value mg/dL.
And serum Diagnostic_procedure viral Diagnostic_procedure markers Diagnostic_procedure were HBsAg Diagnostic_procedure ( + Lab_value ), anti Diagnostic_procedure - HBs Diagnostic_procedure (-), anti Diagnostic_procedure - HBc Diagnostic_procedure ( + Lab_value ), HBeAg Diagnostic_procedure (-), anti Diagnostic_procedure - HBe Diagnostic_procedure ( + Lab_value ), HBV Diagnostic_procedure - DNA Diagnostic_procedure <20 Lab_value IU/mL Lab_value , anti Diagnostic_procedure - HCV Diagnostic_procedure (-) and anti Diagnostic_procedure - HIV Diagnostic_procedure (-).
The patient's serum Diagnostic_procedure α Diagnostic_procedure - fetoprotein Diagnostic_procedure ( AFP Diagnostic_procedure ) was 676.5 Lab_value ng/mL Lab_value and carbohydrate Diagnostic_procedure antigen Diagnostic_procedure 19 Diagnostic_procedure - 9 Diagnostic_procedure ( CA19 Diagnostic_procedure - 9 Diagnostic_procedure ) <0.6 Lab_value U/mL.
She took an abdominal Biological_structure CT Diagnostic_procedure scan, which showed a 9 Distance cm Distance sized necrotic Detailed_description mass Sign_symptom with Detailed_description internal Detailed_description hemorrhage Detailed_description at the right Biological_structure hepatic Biological_structure lobe Biological_structure and ruptured Biological_structure to Biological_structure peritoneum Biological_structure (Fig.1A), so an emergency Detailed_description hepatic Biological_structure central Biological_structure bisectionectomy Therapeutic_procedure was done (Fig.2A).
The initial histological diagnosis was cHCC Disease_disorder - CC Disease_disorder with spindle Detailed_description cell Detailed_description metaplasia Detailed_description of Detailed_description cholangiocarcinoma Detailed_description element Detailed_description (Fig.2B).
The serum Diagnostic_procedure AFP Diagnostic_procedure was decreased Lab_value to 7.67 Lab_value ng/mL Lab_value at time of discharge Clinical_event .
Regarding as cHCC Disease_disorder - CC Disease_disorder , postoperative adjuvant Detailed_description chemotherapy Medication with tegafur/uracil Medication ( UFT Medication ) was administrated for 3 Duration months Duration .
3 Date months Date later Date , follow Clinical_event - up Clinical_event abdominal Biological_structure CT Diagnostic_procedure scanning showed previously unseen a 5.5 Distance cm Distance sized left Biological_structure subphrenic Biological_structure mass Sign_symptom with mild Severity enhancement Sign_symptom in delayed Detailed_description image Detailed_description (Fig.3A, B) and AFP Diagnostic_procedure was increased Lab_value to 312.06 Lab_value ng/mL.
She underwent laparoscopic Detailed_description splenectomy Therapeutic_procedure with mass Therapeutic_procedure excision Therapeutic_procedure .
On histologic Diagnostic_procedure examination Diagnostic_procedure , mesenchymal Diagnostic_procedure elements Diagnostic_procedure consisted of a proliferation Lab_value of Lab_value primitive Lab_value - appearing Lab_value mesenchymal Lab_value spindle Lab_value - shaped Lab_value cells Lab_value , intimately Detailed_description admixed Detailed_description with Detailed_description the Detailed_description epithelial Detailed_description elements Detailed_description in Detailed_description a Detailed_description highly Detailed_description cellular Detailed_description pattern Detailed_description .
Cytoplasm Diagnostic_procedure was more Lab_value abundant Lab_value than Lab_value that Lab_value of Lab_value mature Lab_value fibroblasts Lab_value , and the nucleus Diagnostic_procedure was elongated Shape and plump Shape .
These cells Lab_value blended Lab_value progressively Lab_value with Lab_value areas Lab_value of Lab_value less Lab_value intense Lab_value cellular Lab_value mesenchymal Lab_value proliferation Lab_value , and with relatively Detailed_description acellular, Detailed_description fibrous Detailed_description septa Detailed_description .
Osteoid Diagnostic_procedure was present Lab_value either within Detailed_description the Detailed_description primitive Detailed_description mesenchyme Detailed_description , near Detailed_description the Detailed_description fibrous Detailed_description septa Detailed_description or Detailed_description pseudocapsule Detailed_description , or admixed Detailed_description within Detailed_description the Detailed_description epithelial Detailed_description elements Detailed_description .
Osteoid Diagnostic_procedure foci Diagnostic_procedure contained cells Lab_value morphologically Lab_value identical Lab_value to Lab_value osteoblasts Lab_value (Fig.4A).
The immunohistochemistry Diagnostic_procedure stains Diagnostic_procedure showed expression Lab_value of hepatocyte Diagnostic_procedure , β Diagnostic_procedure - HCG Diagnostic_procedure , AFP Diagnostic_procedure , vimentin Diagnostic_procedure , CK7 Diagnostic_procedure , CK19 Diagnostic_procedure , CD56 Diagnostic_procedure and β Diagnostic_procedure - catenin Diagnostic_procedure and negativity Lab_value for CEA.(Fig.4B, C, D, E, F, G).
Metastatic Detailed_description hepatoblastoma Disease_disorder was confirmed by histologic Diagnostic_procedure examination Diagnostic_procedure with immunohistochemistry Diagnostic_procedure stains Diagnostic_procedure , so immunohistochemistrically re-examination of previous surgical specimens was also confirmed as hepatoblastoma.
Follow Clinical_event - up Clinical_event abdominal Biological_structure CT Diagnostic_procedure scan performed 1 Date month Date after Date reoperation showed a newly Detailed_description onset Detailed_description 1.7 Distance cm Distance sized subtle Detailed_description enhancing Detailed_description soft Detailed_description tissue Detailed_description mass Sign_symptom in splenic Biological_structure bed Biological_structure , and positron Diagnostic_procedure emission Diagnostic_procedure tomography Diagnostic_procedure ( PET Diagnostic_procedure ) showed multiple Detailed_description FDG Detailed_description uptake(max SUV Lab_value > Lab_value 3.80 Lab_value ) in left Detailed_description upper Detailed_description and lower Detailed_description quadrant Detailed_description area of abdomen Biological_structure , paralumbar Biological_structure area Biological_structure including Biological_structure right Biological_structure subphrenic Biological_structure area Biological_structure (Fig.5A, B, C).
Follow Clinical_event - up Clinical_event AFP Diagnostic_procedure was 162.69 Lab_value ng/mL.
Systemic Detailed_description chemotherapy Medication started with cisplatin Medication ( 60 Dosage mg/m2 Dosage ), 5 Medication - fluorourasil Medication ( 5 Medication - FU Medication ) ( 600 Dosage mg/m2 Dosage ), vincristine Medication ( 1.5 Dosage mg/m2 Dosage ) and total 3 Frequency cycles Frequency of chemotherapy were done every Frequency 4 Frequency week Frequency .
Entecavir Medication 0.5 Dosage mg Dosage was also started for chemoprophylaxis Medication of CHB Disease_disorder .
After the 3rd chemotherapy cycle, follow Clinical_event - up Clinical_event abdominal Biological_structure CT Diagnostic_procedure and PET Diagnostic_procedure scan showed progression of multiple Detailed_description intraperitoneal Biological_structure metastasis Sign_symptom with large Severity amount Severity of intraperitoneal Biological_structure fluid Sign_symptom (Fig.6A, B) and follow Clinical_event - up Clinical_event AFP Diagnostic_procedure was further increased Lab_value to 254 Lab_value ng/mL.
So chemotherapy Medication regimen was changed to carboplatin Medication ( 350 Lab_value mg/m2 Lab_value ) with doxorubicin Medication ( 30 Lab_value mg/m2 Lab_value ) every Frequency 3 Frequency weeks Frequency .
The patient experienced neutropenia Sign_symptom after the new regimen, but recovered Sign_symptom shortly after treatment with granulocyte Medication colony Medication - stimulating Medication factor Medication ( G Medication - CSF Medication ).
After second carboplatin with doxorubicin chemotherapy, follow Clinical_event - up Clinical_event AFP Diagnostic_procedure was increased Lab_value 1510.19 Lab_value ng/mL Lab_value , but abdominal Biological_structure CT Diagnostic_procedure scan showed that amount of ascites Sign_symptom was decreased (Fig.7).
Because of radiologic improvements, third and fourth chemotherapy Medication were performed.
After 4th chemotherapy, follow Clinical_event - up Clinical_event abdominal Biological_structure CT Diagnostic_procedure revealed progression of multiple Detailed_description intraperitoneal Biological_structure metastatic Detailed_description masses Sign_symptom , newly developed hepatic Biological_structure metastasis Sign_symptom and large Severity amount Severity of intraperitoneal Biological_structure fluid Sign_symptom (Fig.8).
A diagnostic paracentesis Diagnostic_procedure was performed and showed white Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure 310/mm3 Lab_value ( poly Diagnostic_procedure 20% Lab_value , lymph Diagnostic_procedure 80% Lab_value ), protein Diagnostic_procedure 3.6 Lab_value g/dL Lab_value and albumin Diagnostic_procedure 2.3 Lab_value g/dL Lab_value on ascitic Diagnostic_procedure fluid Diagnostic_procedure analysis Diagnostic_procedure .
The serum Diagnostic_procedure albumin Diagnostic_procedure was 3.1 Lab_value g/dL Lab_value and serum Diagnostic_procedure - ascites Diagnostic_procedure albumin Diagnostic_procedure gradient Diagnostic_procedure ( SAAG Diagnostic_procedure ) was 0.8 Lab_value g/dL.
The AFB Diagnostic_procedure stain Diagnostic_procedure and Diagnostic_procedure culture Diagnostic_procedure were all negative Lab_value in ascitic Detailed_description fluid Detailed_description .
The AFP Diagnostic_procedure was 6881.93 Lab_value ng/mL Lab_value on serum Detailed_description .
Regarded as peritoneal Biological_structure carcinomatosis Disease_disorder , the patient underwent conservative Therapeutic_procedure treatments Therapeutic_procedure including the use of repeated Detailed_description therapeutic Therapeutic_procedure paracentesis Therapeutic_procedure for 1 Duration month Duration before death Outcome .