case_images: PMC10864504_01
case_images: MRI imaging before operation on 9 September, 2021 of the reported case in Gaoyou People's Hospital (Jiangsu, China). The results indicated cholecystolithiasis, cholecystitis, and cholangitis, as well as hemangioma-like changes in the left lobe of the liver (red arrow).
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case_images: Upper abdomen magnetic resonance imaging (MRI) indicated cholecystolithiasis, cholecystitis, and cholangitis, as well as hemangioma-like changes in the left lobe of the liver (Figure 1).
case_images: (A) HE staining of cancerous tissues from the gallbladder (magnification times: left panel x40, middle panel x100, right panel x200). (B) HE staining of the liver biopsy tissues (magnification times: left panel x40, middle panel x100, right panel x200). (C) Immunohistochemical staining showed CK7 positive, CK19 positive, INSM1 positive, Ki-67 positive, Syn, CgA positive, CD56 positive, and MUC-1-positive staining of malignant tissues (magnification times: x40).
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case_images: The postoperative pathology showed poorly differentiated adenocarcinoma combined with neuroendocrine carcinoma, with the cancer tissues invading the full thickness of the gallbladder wall (Figure 2A). In addition, a poorly differentiated neuroendocrine carcinoma was also found in the liver biopsy, which was considered to be a metastatic malignancy (Figure 2B). The immunohistochemistry results of the surgical specimens are as follows: insulinoma-associated protein 1 (INSM1) (+), chromogranin A (CgA) (+), synaptophysin (Syn) (+), cluster of differentiation 56 (CD56) (+), P53 (weakly positive), Ki-67 (80%+), cytokeratin 7 (CK7) (+), mucin 1 (Muc-1) (mostly +), cytokeratin 19 (CK19) (partially +), and S100P (partially +) (Figure 2C), supporting the diagnosis of GB-NEC.
case_images: Timeline of the clinical course. Right: MRI and CT images of baseline (12 November, 2021) and after therapy (red array: metastatic cancer in the liver, yellow array: metastatic lymphoma nodes).
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case_images: A single intrahepatic metastatic tumor (approximately 5.0 x 4.8 cm in size) and portal lymph node metastases (approximately 2.4 cm in diameter) were found by contrast-enhanced MRI (Figure 3). The MRI results before the third cycle of treatment (6 January, 2022) showed that the intrahepatic tumor significantly reduced to approximately 2.0 x 2.0 cm in size, and the metastatic hilar lymphoma nodes (LNs) were missed (Figure 3). After the completion of 8 cycles of treatment (4 May, 2022), the patient was assessed as having a PR, with the size of the intrahepatic tumor further being reduced to 2.0 x 1.5 cm (Figure 3). Next, maintenance therapy using tislelizumab alone (200 mg, intravenous injection) was given every 3 weeks from 7 May, 2022 (Figure 3), and the therapeutic efficacy was re-evaluated as PR on 18 August, 2022.
case_images: (A) Alteration of NSE levels of the patient during the course of therapy. (B-G) Serum biochemical parameters during the course of therapy. (H-K) The results of routine blood test during the course of therapy.
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case_images: The blood NSE of the case remarkably decreased to 13.36 ng/mL before the fourth therapy and remained at normal levels since then (Figure 4A). During the 8 cycles of treatment, no serious adverse events (AEs) were observed (Figure 4).