Background
Reactive cutaneous capillary endothelial proliferation (RCCEP) is a common adverse event of camrelizumab in the treatment of advanced hepatocellular carcinoma. Facial skin metastasis is an exceptionally uncommon occurrence in hepatocellular carcinoma (HCC). It can be easily mistaken for a prevalent complication known as RCCEP, particularly when it manifests as a persistently enlarging tumor-like mass. This case report highlights a prototypical instance where a metastasis in the nasal alar region of HCC was mistakenly diagnosed as RCCEP during immunotherapy. The findings of this report hold significant clinical value in guiding the management of larger RCCEP lesions encountered during immunotherapy.
Case Description
In this case, the patient is a male with a history of hepatitis B. In October 2015, he was diagnosed with HCC. In April 2020, he commenced treatment with ramucirumab (200 mg every 3 weeks) as tumor progression. However, during the third treatment cycle, the patient experienced RCCEP, predominantly affecting the head, neck, trunk, and limbs. To address this, sequential administration of apatinib was initiated, resulting in the gradual regression of RCCEP in these areas. Unfortunately, the metastatic lesion in the nasal alar region continued to grow, exhibiting a tumor-like appearance. On January 25, 2021, surgical resection was performed to remove the nasal alar lesion, and subsequent pathological examination confirmed it as a liver metastasis. Post-surgery, radiation therapy was administered to effectively manage the remaining lesion in the nasal alar region. Importantly, the treatment of the nasal alar metastasis did not hinder the comprehensive management of HCC. The patient obtained excellent curative effect.
Conclusions
During the course of immunotherapy for HCC, the emergence of a larger RCCEP lesion that does not show signs of regression even with vigorous treatment raises the suspicion of skin metastasis. It is difficult to distinguish metastatic tumor on the skin from morule- and tumor-like RCCEP that does not easily resolve. To obtain a definitive diagnosis, an early pathological biopsy is crucial. If confirmed as a metastatic tumor, prompt consideration should be given to implementing curative surgical resection.
How to quickly and accurately identify the quality of grain seed, grain type and other basic indicators and improve the efficiency of breeding quality, wheat production and quality in the work of selection or breeding have become a serious problem. The project developed the necessary software and hardware detection device platform, carried out research on the segmentation and counting algorithms of particle images for the system, and designed and implemented image processing techniques based on particle quality grain seed of the determination system. The result of the research has broad application prospects.
For the shortage of artificial methods in classification of apple level, a method of classification of apple level based on BP artificial neural networks is presented. Artificial neural network provides technical means for research on apple classification, because it can provide nonlinear mapping of the input vector and output vector with arbitrary dimension, and also can reach any nonlinear continuous system. The BP neural network model is established for the classification by taking feature parameters as input vectors and apple level as output vectors. The results has shown that the classification precision of model is very high, and which has good application in realizing automatic identification of apple level.
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