case_images: PMC10853339_01
case_images: Microscopic pictures. (A) Neuroendocrine carcinoma (HE, x100). Microscopically, the tumor cells were arranged in a diffuse-like, cable-like manner. (B) Neuroendocrine carcinoma: (HE, x200). It is composed of tumor cells with the same size, large nucleus, obvious nucleolus, abundant cytoplasm, and easy to see the mitotic image. (C) Neuroendocrine carcinoma (HE, x400). It is easy to see the mitotic image. (D) Chromogranin A is negative in a neuroendocrine carcinoma (x200). (E) Syn is focally expressed in a neuroendocrine carcinoma (x400). (F) CD56 is expressed in a neuroendocrine carcinoma (x200). (G) Ki-67 is expressed in a neuroendocrine carcinoma, about 85% (x200).
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case_images: Histopathological and immunohistochemistry findings were suggestive of ovarian LCNEC (Stage IIIA) with positive expression for synaptophysin, CD56, and ki-67 ( Figure 1 ).
case_images: Microscopic pictures. (A) Low-power view of poorly differentiated carcinoma of the ovary (HE, x200). (B) High-power view of poorly differentiated carcinoma of the ovary (HE, x200). (C) HER-2 is positive in the carcinoma (x200). (D) HER-2 is positive in the carcinoma (x400). The cell membrane of cancer cells is weakly stained.
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case_images: f2
case_images: Therefore, we performed further pathological examination, which indicated that the tumor was poorly differentiated carcinoma, and immunohistochemical results showed CgA(-), Syn(-), CD56(-), and her2(1+) ( Figure 2 ).
case_images: Diagram of the patient's treatment course. PD, Progressive disease; PR, Partial response.
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case_images: Based on this result, the patient accepted T-DXd beginning in May 2022 ( Figure 3 ).
case_images: Patient's CT imaging before and during T-DXd treatment. (A) The para-aortic lymph nodes were enlarged (2022-5-13); (B) The para-aortic lymph nodes decreased after T-DXd treatment (2022-6-29).
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case_images: f4
case_images: Nevertheless, CT examination on 22 September 2022 revealed that the pelvic lesions were enlarged, and the disease progressed again ( Figure 4 ).