Figure 2.

Incidentally found, large solitary tumour in a 55-y-o female. Histology confirmed a G3 sarcomatous hepatocellular carcinoma, baseline MRI (a – c). Initial treatment with two superselective TACE (40 µm particles loaded with 100 mg doxorubicin) resulted in substantial necrosis of the tumor with still some growth in the periphery; asterix (d- f). Sytemic therapy with a proteinkinase inhibitor (sorfenib) was not tolerated and switched to a checkpoint-inhibitor (PD-1 inhibitor, nivolumab). Nivolumab could maintain (g – i) and promote the tumor necrosis, last control study in 5/2020 (j – l). 5 years after initial diagnosis, the patient is still alive without compromized life quality. The asymptomatic, incidentally in 2017 detected Standford type B aortic dissection was not treated yet since the patient refused to any other treatments beside the HCC therapy. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization. (Left column: T₂W; middle: DWI ADC map; right: T₁W 20 min post Gd-EOB DTPA)