Contrast-enhanced Ultrasonography Features for Diagnosing Pseudoprogression of Hepatocellular Carcinoma with Immunotherapy: A Case Report of the Response after Pseudoprogression

Shin Otake; Yu Ota; Kazunobu Aso; Mitsuyoshi Okada; Hidemi Hayashi; Takumu Hasebe; Shunsuke Nakajima; Koji Sawada; Mikihiro Fujiya; Toshikatsu Okumura

doi:10.2169/internalmedicine.2349-23

CASE REPORTS

Contrast-enhanced Ultrasonography Features for Diagnosing Pseudoprogression of Hepatocellular Carcinoma with Immunotherapy: A Case Report of the Response after Pseudoprogression

Shin Otake, Yu Ota, Kazunobu Aso, Mitsuyoshi Okada, Hidemi Hayashi, Takumu Hasebe, Shunsuke Nakajima, Koji Sawada, Mikihiro Fujiya, Toshikatsu Okumura

Author information

Shin Otake
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Yu Ota
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Kazunobu Aso
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Mitsuyoshi Okada
Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Hidemi Hayashi
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Takumu Hasebe
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Shunsuke Nakajima
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Koji Sawada
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Mikihiro Fujiya
Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Toshikatsu Okumura
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan

Keywords: pseudoprogression, contrast-enhanced ultrasonography, hepatocellular carcinoma, immunotherapy

JOURNAL OPEN ACCESS

2024 Volume 63 Issue 8 Pages 1093-1097

DOI https://doi.org/10.2169/internalmedicine.2349-23

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Abstract

A male patient in his 70s with recurrent hepatocellular carcinoma (HCC) after surgery received atezolizumab plus bevacizumab (Atezo+Bev) therapy. Initial computed tomography (CT) revealed tumor growth along with an increase in tumor markers, and contrast-enhanced ultrasonography (CEUS) showed multiple round avascular areas within the nodules with an appearance similar to a slice of Swiss cheese. Continuation of immunotherapy with consideration of the potential for pseudoprogression produced a dramatic response. Although it is difficult to distinguish between true progression and pseudoprogression, the Swiss cheese-like appearance on CEUS may be important for the early diagnosis of pseudoprogression.

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