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

• Published in: Internal Medicine Vol. 63; no. 8; pp. 1093 - 1097
• Main Authors: Otake, Shin, Ota, Yu, Aso, Kazunobu, Okada, Mitsuyoshi, Hayashi, Hidemi, Hasebe, Takumu, Nakajima, Shunsuke, Sawada, Koji, Fujiya, Mikihiro, Okumura, Toshikatsu
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.04.2024; Japan Science and Technology Agency
• Subjects: Bevacizumab; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Cheese; Computed tomography; Contrast Media; contrast-enhanced ultrasonography; Hepatocellular carcinoma; Humans; Immunotherapy; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; pseudoprogression; Tumor markers; Tumors; Ultrasonography - methods; pseudoprogression; contrast-enhanced ultrasonography; hepatocellular carcinoma; immunotherapy
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.2349-23

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.