case_images: PMC10540079_01
case_images: The biopsy of the right supraclavicular lymph node. (A-D) The first biopsy of the right supraclavicular lymph node. (A) Hematoxylin and eosin-stained staining of the right supraclavicular lymph node. (B) Immunohistochemical staining of CK. (C) Immunohistochemical staining of p63. (D) Immunohistochemical staining of TTF-1. (E-H) The second biopsy of the right supraclavicular lymph nodes. (E) Hematoxylin and eosin-stained section of the right supraclavicular lymph node. (F) Immunohistochemical staining of CK. (G) Immunohistochemical staining of p63. (H) Immunohistochemical staining of TTF-1.
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case_images: NAPSINA (-), Ki-67 (60%+) ( Figures 1A-D ). Next-generation sequencing (NGS) analysis was performed and identified. PD-1 ( Figure 3C ) and PD-L1 expression (22C3 pharmDx assay, Agilent Technologies), particularly with PD-L1 expression in the basal layer of the skin ( Figure 3D ) and in the glands ( Figure 3E ). PD-L1 expression in tonsil tissue was used as a control to verify antibody specificity ( Supplementary Figure 1 ). TTF-1 (+), NAPSINA (-), P40 (-), P63(-), CK5/6(-), 35BH11(+), CK (+), Ki-67 (70%+) ( Figures 1E-H ). Two cycles of chemotherapy with pemetrexed were administered, however the tumors continued to grow and the patient's physical state was not adequate for further chemotherapy.
case_images: Skin and lips mucosa injury. The localized skin lesions presented with erosions on hands (A) and feet (B). (C) The erythema was on the back. (D) The lips mucosa had painful erosions.
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case_images: Hands and feet started to be swollen and blistered ( Figure 2 ).
case_images: The biopsy of the skin lesion of right forearm. (A-B) Hematoxylin and eosin-stained staining of skin biopsy. The biopsy of the skin lesion showed local keratinocytic necrosis (A) and subepidermal split (B). (C) PD-1 expression in skin lesion. (D) PD-L1 expression in the basal layer of the skin. (E) PD-L1 expression in the glands of the skin. (F) CD4+ T lymphocyte infiltration in the skin. (G) CD8+ T lymphocyte infiltration in the skin.
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case_images: It showed epidermal necrosis and subepidermal split ( Figures 3A, B ), consistent with SJS. PD-1 ( Figure 3C ) and PD-L1 expression (22C3 pharmDx assay, Agilent Technologies), particularly with PD-L1 expression in the basal layer of the skin ( Figure 3D ) and in the glands ( Figure 3E ). PD-L1 expression in tonsil tissue was used as a control to verify antibody specificity ( Supplementary Figure 1 ). We also performed CD4 and CD8 positive T lymphocyte expression assay, and the results showed positive CD4 ( Figure 3F ) and CD8 ( Figure 3G ) positive T lymphocyte infiltration.
case_images: Timeline of treatment and diagnostic assessment of lung lesions during treatment.
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case_images: On July 2021, the tumor was progression again and the radioactive iodine-125 particles were implanted ( Figure 4 ). On July 28, 2021, the tumor of right lung was significantly larger than previous detection (approximately 7.2 cm x3.6 cm) ( Figure 4 ).