The patient was 56 years old, and she underwent ultrasound examination because of wasting and poor nasal function, and was found to have abdominal occupancy and multiple liver occupancies. The figure below.
The tumor in the abdominal cavity caused the diaphragm to be compressed upward and a small amount of fluid was accumulated in the left thoracic cavity.
The tumor is huge with compression of the left chest and heart. Multiple metastases were seen in the liver.
The tumor compresses the stomach and spleen and adheres closely to the abdominal wall, and multiple metastases in the liver.
The tumor occupies the upper middle part of the left abdominal cavity and projects into the thoracic cavity. Multiple metastases in the liver are found in all segments of the liver, totaling dozens of them.
Metastases in the hilar region with huge abdominal occupancy.
Abdominal occupancy compressing organs such as gastrointestinal pancreas spleen and kidney with multiple metastases in the liver.
Multiple metastases in the liver with giant abdominal occupancy.
Multiple metastases in the liver spread over all segments of the liver, with necrosis visible in the center of the abdominal cavity occupation and seemingly invaded pancreas.
Massive abdominal occupancy.
Massive abdominal occupancy with central necrosis.
Massive abdominal occupancy with multiple surrounding organs under compression.
The onset of the disease was in March 2011. The patient sought medical help from all over the world, but hepatobiliary surgery, gastrointestinal surgery, and oncology all refused to admit him and suggested supportive treatment.
Later, he was referred to me by his colleagues.
After reviewing the film, I suggested: if the biopsy confirmed mesenchymal stromal tumor, then aggressive treatment; otherwise, supportive treatment.
A CT-guided puncture biopsy was performed and confirmed: mesenchymal tumor (hypofractionated) with multiple metastases in the liver.
Interventional embolization was performed in April 2011, and the artery supplying the abdominal tumor was found on imaging and embolized.
The splenic artery also had blood supply and was embolized at the same time.
After embolization, iodine oil sink was seen in the abdominal tumor.
Three weeks later, double-needle microwave ablation of the abdominal mesenchymal tumor was performed.
May 2011 Embolization of metastatic tumor in the liver was performed.
July 2011 Ablation of multiple metastases in the liver was performed in batches.
In August 2011, another interventional embolization treatment was performed.
October 2011, another interventional embolization treatment.
On review in October 2011, the abdominal tumor was significantly reduced and did not show enhancement, and the liver tumor did not show enhancement, suggesting basic tumor inactivation.
Both the abdominal cavity and liver tumor did not show any enhancement, suggesting that the tumor was basically inactivated.
The patient’s symptoms disappeared and he could work and live normally, and his weight increased significantly.
January 2012 Interventional angiography did not show obvious tumor staining.
After discussion with gastrointestinal surgery, Gleevec oral therapy was given.
In April 2012, on review, the liver tumor did not show any enhancement, and the abdominal tumor further shrank, but there seemed to be a little enhancement in some locations. Surgery was recommended to remove the abdominal tumor, and the patient had concerns about the risk of surgery and continued Gleevec oral treatment.
In April 2012, the liver tumor did not intensify and the abdominal tumor shrank further, but there seemed to be a little enhancement in some locations.
In April 2012, the liver tumor did not intensify and the abdominal tumor shrank further, but there seemed to be a little enhancement in some locations.
In April 2012, the liver tumor did not intensify and the abdominal tumor shrank further, but there seemed to be a little enhancement in some locations.
In April 2012, the liver tumor did not intensify and the abdominal tumor shrank further, but there seemed to be a little enhancement in some locations.
In September 2012, the MRI was repeated and the liver tumor did not intensify, while the abdominal tumor shrank but still had a little enhancement. The patient refused surgery, so he was given another ablation treatment.
In October 2012. The abdominal tumor was treated with microwave ablation again.
In January 2013, the MR was repeated, and the liver tumor did not strengthen, and the abdominal tumor did not strengthen significantly.
In January 2013, the liver tumor did not strengthen and the abdominal tumor did not strengthen significantly. He continued oral treatment with Gleevec.
In May 2014, the MRI was repeated and the liver tumor did not intensify, but the abdominal tumor seemed to intensify.
In May 2014, the MRI of liver tumor did not show any enhancement and the abdominal tumor seemed to have enhancement, so surgery was recommended to remove the abdominal tumor.
In May 2014, the MRI of liver tumor did not show any enhancement and the abdominal tumor seemed to have enhancement, so surgery was recommended to remove the abdominal tumor.
In May 2014, the liver tumor did not intensify and the abdominal cavity tumor seemed to intensify on MRI, and surgery was recommended to remove the abdominal cavity tumor.
In September 2014, the patient developed severe anemia, and the repeat MRI revealed that the tumor invaded the gastric wall leading to gastric perforation.
The tumor invaded the gastric wall leading to bleeding from the perforated gastric wall. The supportive treatment was ineffective, and surgery was decided after repeated communication with the patient and gastrointestinal surgery.
In December 2014, the review after surgery showed that the liver tumor was not enhanced and the left pleural effusion.
The abdominal tumor had been resected and a small amount of fluid had accumulated in the abdominal cavity.
The abdominal tumor had been resected.
July 2015 No enhancement of liver tumor, abdominal tumor has been removed. Oral Gleevec therapy was continued.
In July 2015, the liver tumor did not intensify, the abdominal cavity tumor had been removed, the anemia had been corrected, and the patient continued to take Gleevec orally and follow up closely.
Point of view.
The patient had multiple tumors in the liver at the time of presentation, a huge occupying abdominal cavity, no indication for surgery, and if treated symptomatically, the patient would have passed away in a short period of time.
We biopsied and confirmed the mesenchymal tumor and then took several interventional embolization and ablation treatments, which not only achieved complete inactivation of dozens of tumors in the liver, but also achieved basic inactivation of abdominal tumors at one time, which was actually very difficult.
Later, the patient developed gastrointestinal bleeding, and MR confirmed that the tumor had recurred and invaded the stomach wall. After decisive surgical resection, the patient finally achieved tumor-free survival on imaging, which can be considered a medical miracle.
The patient is now alive for more than four years and continues to be closely followed. The good results achieved by the patient are also greatly related to the effect of Gleevec.
This case suggests that with full cooperation and joint efforts between the doctor and patient, even very difficult cases still have a chance to achieve a good outcome.