case_images: PMC10245386_01
case_images: Hematoxylin-eosin (H&E) staining and immunohistochemical evaluation of the tissue obtained using needle biopsy (10x). Pathological images show (A) (H&E) staining, (B) positive staining for CK18, (C) positive staining for CK19, (D) positive staining for PD-1, (E) positive staining for PD-L1(10% positive), (F) negative staining for CA125, (G) negative staining for hepatocytes, (H) negative sating for ER, and (I) H&E staining of tumor cells from the ascitic fluid (0.5x).
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case_images: The pathological diagnosis was moderate to poorly differentiated adenocarcinoma ( Figure 1A ). On immunohistochemical evaluation, the tumor tissue was positive for cytokeratin 18, cytokeratin 19, PD-1, and PD-L1 (10%) ( Figures 1B-E ) and negative for CA125, hepatocytes, and ER ( Figures 1F-H ). Tumor cells were identified in the ascitic fluid ( Figure 1I ).
case_images: The PET-CT images for evaluating the treatment response. The metabolic activity change is noticeable in the masses located in the right liver (A), left liver (B), left cervical lymph node (C), retroperitoneal nodes (D), and omentum and ovary (E) (2021-10 is the baseline).
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case_images: The PET/CT scans showed achievement of tumor metabolic activity complete response ( Figure 2 ).
case_images: The MRI scans during the systemic treatment. (A) Upper-row images indicate the maximum diameter of the lesion located in the right liver; Lower row images denote the maximum diameter of the lesion located in the left liver. Arrows in the figures indicate the position of the lesions. (B) The sum of tumor diameters.
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case_images: Compared to the baseline level, the sum of tumor diameters was reduced by 44.6% ( Figure 3 ).
case_images: Diagram depicting the dynamic changes of CA125 (A), phosphorous level (B), and TPOA/TGA (C) over time, after the onset of systemic therapy. (D) The timeline of the treatment protocol. iCCA, intrahepatic cholangiocarcinoma; NGS, next-generation sequencing; PR, partial response.
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case_images: The serum CA125 decreased to 61.83 micro/mL after 1 cycle of the therapy ( Figure 4A ). The timeline of treatment is shown in  Figure 4D . Intake of sevelamer carbonate (0.8 g, tid) decreased the blood phosphorus levels during pemigatinib administration ( Figure 4B ). After receiving levothyroxine replacement, the abnormal TPOA and TGA gradually returned to near-normal levels ( Figure 4C ), and her symptoms eased at the same time.