Figure Legends
Figure 1. (a) Enhanced computed tomography performed before surgical treatment. The black arrowhead indicates the liver tumor. (b) A resected specimen. The black triangle indicates the liver tumor. (c) A low-power-field view of the histological examination revealed components of both hepatocellular carcinoma (HCC; white triangles) and cholangiocarcinoma (white arrowheads). (d) A high-power-field view of the HCC region. (e) A high-power-field view of the cholangiocarcinoma region. (f) Immunohistochemical staining showed that the HCC regions (white triangles) were positive and the cholangiocarcinoma regions (arrowheads) negative for Hepa-para-1. (g) The cholangiocarcinoma regions were positive for CK 19 (h) and CD 56. (i) The HCC regions were negative for programmed death ligand-1 (PD-L1). (j) The cholangiocarcinoma regions were negative for PD-L1.
Figure 2. Enhanced computed tomography showed multiple lymph nodes metastases before Atez/Bev. (a) Lymph nodes around the abdominal aorta. (b) A lymph node behind the inferior vena cava. (c, d) Left supraclavicular lymph nodes
Figure 3. Enhanced computed tomography after two cycles of therapy showed mild shrinkage of enlarged lymph nodes, and the response rate per RECIST was determined to be stable disease. (a) Lymph nodes around the abdominal aorta. (b) A lymph node behind the inferior vena cava. (c, d) Left supraclavicular lymph nodes.
Figure 4. Clinical course. The solid line indicates CA19-9, and the dotted line indicates AFP. Black and white triangles indicate the administration of atezolizumab and bevacizumab, respectively. AFP, alfa-fetoprotein; CA 19-9, carbohydrate antigen 19-9; HR, hepatic resection; GEM/CDDP, gemcitabine and cisplatin; LEN, lenvatinib.
Table 1. Laboratory findings