case_images: PMC10626500_01
case_images: Histopathology and immunohistochemistry (IHC) of PSC. (A, B), H&E stain, original magnification x200. (C), IHC Vimentin(+++), original magnification x200. (D), IHC CK(+), original magnification x200. (E), H&E stain. original magnification x100. (F), PD-L1 IHC (antibody 22C3 pharmDx), original magnification x100. Tumor Proportion Score [aTPS]: 80% and Combined Positive Score [bCPS]: 95. (a.TPS was defined as the percentage of viable tumor cells with partial or complete membrane staining of PD-L1 in at least 100 viable tumor cells. b.CPS was defined as the number of PD-L1 stained cells (tumor cells, lymphocytes, macrophages) divided by the number of all tumor cells and multiplied by 100.).
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case_images: Then, she received the right upper lobe resection and lymph node dissection were performed under thoracoscopy in November 12, 2019, postoperative pathology revealed a right upper lung spindle cell malignant tumor, conformed to sarcoma carcinoma ( Figures 1A, B ), with low differentiation and a maximum diameter of about 8.5 cm. Score [CPS]: 95 ( Figures 1E, F ). The profile of genetic alterations included TP53 mutation, with an abundance of 25.3% ( Supplementary Material 2 ). Consequently, with the patient's consent, pembrolizumab combined with anlotinib began treatment in January 2020. She was administered 200 mg pembrolizumab intravenously over 30 min every 3 weeks and received anlotinib orally at 10 mg day 1-14 every 3 weeks.
case_images: Tumor recurrence and metastasis region. (A, B), 7 weeks after surgery, positron emission tomography/computed tomography (PET-CT) revealed tumor recurrence and metastasis, involving a huge mass shadow in the right-side area of the mediastinum (solid tumor, dmax = 70 mm * 44 mm), abnormal increase in FDG metabolism, SUVmax 28, (C, D), Supraclavicular fossa lymph nodes, (E, F), right mediastinum lymph nodes, (G, H), right cardio-diaphragmatic angle metastatic lymph nodes.
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case_images: S-100(-), BRG1(+). The postoperative diagnosis was PSC IIIB stage (pT4N2M0, 8th edition AJCC). Seven weeks after surgery, PET-CT revealed tumor recurrence and metastasis ( Figure 2 ), involving a huge mass shadow in the right-side area of the mediastinum (70 mm * 44 mm), abnormal increase in FDG metabolism, SUVmax 28 ( Figures 3A, B ), and right upper and lower clavicle socket, right axilla, mediastinum, and right cardio-diaphragmatic angle showed metastatic lymph nodes.
case_images: Imaging changes of patients before and after treatment. (A, B), Baseline PET-CT findings of the patient's course (solid tumor, dmax = 70 mm * 44 mm, abnormal increase in FDG metabolism and SUVmax 28). (C, D), After 7 cycles of treatment (solid tumor, dmax = 54 mm * 43 mm, abnormal increase in FDG metabolism and SUVmax 7.4). (E, F), After 15 cycles of treatment (solid tumor, dmax = 46mm * 33mm, and no tumor activity and SUVmax 2.4). (G, H), After 34 cycles of treatment Computer Tomography results (solid tumor, dmax = 22mm * 20mm).
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case_images: S-100(-), BRG1(+). The postoperative diagnosis was PSC IIIB stage (pT4N2M0, 8th edition AJCC). Seven weeks after surgery, PET-CT revealed tumor recurrence and metastasis ( Figure 2 ), involving a huge mass shadow in the right-side area of the mediastinum (70 mm * 44 mm), abnormal increase in FDG metabolism, SUVmax 28 ( Figures 3A, B ), and right upper and lower clavicle socket, right axilla, mediastinum, and right cardio-diaphragmatic angle showed metastatic lymph nodes. The metabolic activity of the tumor has significantly decreased compared to before, with SUVmax decreasing to 7.4 ( Figures 3C, D ). After 15 cycles therapy (December 8, 2020), PET-CT depicted reduced right anterior metastasis (46 mm * 33 mm) and minimal metabolic activity with SUVmax 2.4 ( Figures 3E, F ). Afterwards, pembrolizumab combined with anlotinib continued treatment until December 2021, with further reduction of lung malignancies ( Figures 3G, H ).
case_images: Timeline of treatment process.
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case_images: The patient is in long-term survival with tumors ( Figure 4 ).