case_images: PMC11439620_01
case_images: Preoperative ultrasound examination and intraoperative investigation of the patient. (A) Lunar 4, 2021: A 7.0*7.6 cm cystic mass was found in the upper left part of the uterus, with a thick cyst wall and multiple slightly hyperechoic protrusions. (B) May 10, 2022: A 12.8x10.1x5.8 cm solid cystic mass with a detached and multilocular cystic portion was present in the right adnexal region. The mass crosses the anterior aspect of the uterus and involves the left ovary. (C) Exophytic granular masses in the adnexal region bilaterally. (D) Granular metastatic nodules in the greater omentum.
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case_images: PMC11439620_01_fonc-14-1458817-g001.jpg
case_images: f1
case_images: Granular nodules, most of which were loosely attached to the metastatic site, and enlarged lymph nodes of approximately 5 x 4 cm in size were found on the left side of the abdominal aorta and below the renal vessels, which were fixed, and no obvious enlargement of the pelvic lymph nodes was detected as shown in  Figure 1 .
case_images: Hematoxylin-eosin staining and Immunohistochemical staining (both 400+). (A) High magnification micrograph showing medium-sized oval tumor cells with eosinophilic cytoplasm, atypical nuclei, prominent nucleoli, pronounced nuclear grooves, and increased mitotic activity (red arrowheads). (B) Calretinin positivity. (C) focal CK positivity. (D) CD10+ positivity.
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case_images: PMC11439620_01_fonc-14-1458817-g002.jpg
case_images: f2
case_images: Immunohistochemistry results revealed the following: CKpan (+), Vimentin (partially +), ER (++, about 30%), PR (++, about 15%), Calretinin (+), Inhibin alpha (a small amount of +), CD10 (+), beta-Catenin (membrane +), and Ki-67 (+, 40%) as shown in  Figure 2 .
case_images: Curve of CA125 with treatment regimen. Tumor cell reduction (R1) was performed in May 2022, with the preoperative tumor marker value as the baseline. The treatment regimen included: (1) 1 course of treatment with "albuminpaclitaxel + carboplatin" followed by 2 courses of treatment with "albuminpaclitaxel + carboplatin + bevacizumab"; (2) 3 courses of "Domene + cyclophosphamide + bevacizumab"; (3) 5 courses of "Docetaxel + Nedaplatin + bevacizumab"; (4) 5 courses of "bevacizumab" maintenance treatment; (5) 3 courses of "gemcitabine + bevacizumab"; (6) 4 courses of Gemcitabine + oxaliplatin + Renvastinib; and (7) 4 months treatment with "Letrozole + lenvatinib".
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case_images: PMC11439620_01_fonc-14-1458817-g003.jpg
case_images: f3
case_images: However, the tumor markers continued to rise, and new lesion progression (PD) was observed during the maintenance treatment phase as shown in  Figure 3 .
case_images: CT examination of the patient (the trend of lesion change with the change of treatment regimen).
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case_images: PMC11439620_01_fonc-14-1458817-g004.jpg
case_images: f4
case_images: Considering the poor response to anastrozole, the patient's treatment was adjusted on November 20, 2023, to oral maintenance therapy of lenvatinib 12 mg qd combined with letrozole 2.5 mg qd, and the patient has been treated with this regimen for 7 months, with the metastatic lesions progressively reduced, and the tumor markers, such as CA125, have continued to decrease to normal levels, with remarkable therapeutic effects as shown in  Figure 4 .