case_images: PMC10875622_01
case_images: (A) HE staining of the thyroid mass showed invasive ductal carcinoma of mammary origin. (B) IHC examination revealed the thyroid mass was positive for PD-L1.(C) Breast MR showed a right breast nodule (red arrow), BI-RADS category 4 (1.1cm x 0.8cm x 0.8cm). (D) CT of the neck, chest and abdomen showed primary breast cancer with thyroid metastases (red arrow meant metastatic lesion).
case_images: OTT-17-103-g0001.jpg
case_images: PMC10875622_01_OTT-17-103-g0001.jpg
case_images: f0001
case_images: PR (-), GATA-3 (+), P120 (+), Ecad (+), TTF-1 (-), CK7 (+), CK20 (-), Villin (-), CK5/6 (-). PD-L1 expression was assessed by immunohistochemistry using a rabbit monoclonal anti-human PD-L1 antibody (Ventana SP142); the percentage of positive tumour cells was 26-49% (Figure 1B).  Breast MR showed a right breast nodule, BI-RADS category 4 (1.1cm x 0.8cm x 0.8cm) (Figure 1C). CT of the neck, chest and abdomen showed primary breast cancer with thyroid metastases (Figure 1D), multiple enlarged lymph nodes in the neck and bilateral axillae, solid occupancy in the upper lobe of the left lung, mediastinal and bilateral hilar lymph node metastases, left pleural effusion and increased density in the S1 vertebrae.
case_images: (A) HE staining of the right breast mass showed invasive carcinoma of the breast. (B) IHC examination revealed the right breast mass was positive for PD-L1. (C) Breast MR showed a significantly enlarged right breast mass (1.6cm x 1.2cm x 1.1cm) (red arrow) after 3 cycles of TE regimen chemotherapy. (D) CT scan of the neck, chest and abdomen showed significantly enlarged metastases (red arrow) in the thyroid gland after 3 cycles of TE regimen chemotherapy. (E) CT showed thyroid metastases regressed completely following 6 cycles of albumin paclitaxel plus PD-1 antibody. (F) MR showed right breast lesion regressed completely following 6 cycles of albumin paclitaxel plus PD-1 antibody.
case_images: OTT-17-103-g0002.jpg
case_images: PMC10875622_01_OTT-17-103-g0002.jpg
case_images: f0002
case_images: TTF-1 (-), GCDFP-15 (-), Ki-67 index (65%). Expression of the PD-L1 protein was evaluated with an immunohistochemical method using a mouse monoclonal anti-human PD-L1 antibody (Clone 22C3, Dako); PD-L1 positive tumor cells within the tumor tissue specimen were 80% (Figure 2B). Unfortunately, after three cycles, the patient again developed a sensation of neck swelling and a repeat breast MR showed a significantly enlarged right breast mass (1.6cm x 1.2cm x 1.1cm) (Figure 2C). CT scan of the neck, chest and abdomen showed significantly enlarged metastases in the thyroid gland (Figure 2D) and multiple lymph node metastases in the bilateral neck and clavicular region, which were larger than before; solid occupancy in the upper lobe of the left lung did not change significantly and the overall evaluation was progressive disease. Excitingly, both the thyroid metastases (Figure 2E) and the right breast lesion (Figure 2F) regressed completely following six cycles of treatment.