Figure 1 CT scan data and bone marrow smear.(A, B) Contrast-enhanced abdominal computed tomography (CT) scan performed at the time of referral to our hospital, in September 2023. Images A and B show different slices from the same CT study. (A) 11) Hepatocellular carcinoma (HCC) lesion. (B) 2), 3) HCC lesion; 4) metastatic legion in the right adrenal gland; 5) clear cell renal cell carcinoma (ccRCC) lesion. (C) Contrast-enhanced abdominal CT scan in April 2024. 6) Shrinkage of HCC lesion; 7) no obvious change in the size of the right adrenal gland; 8) stable size of the ccRCC lesion. (D) Contrast-enhanced abdominal CT scan in April 2025 (on admission). 9) Further shrinkage of the HCC lesion; 10) enlargement of the right adrenal gland metastasis; 11) development of ascites; 12) stable size of the ccRCC lesion. (E) Bone marrow aspiration smear on admission before initiating vitamin B12 administration. Megaloblastic changes are observed in erythroblasts (red arrows). (May-Giemsa stain, ×1000).