case_images: PMC11219944_01
case_images: (A-E) respectively demonstrate the changes in the volume of the target lesion from late May 2022 before the second surgery to after using different treatment regimens.
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case_images: The maximum cross-sectional dimension of the target lesion measures approximately 117x130 mm ( Figures 1A ,  2A ). Considering the results of the ECT examination and the presence of bone metastasis, it indicates disease progression. ( Figures 1B ,  2B ). CT reassessment at the end of September 2022. ( Figure 1C ). Compared to the end of July 2022, the maximum cross-sectional dimension of the target lesion is approximately 115x54mm. The assessment indicates disease progression ( Figure 1E ).
case_images: (A, B) show the patient developed bone metastases in early August 2022, prominently involving T6, T7, and T10. HE, 40 x magnification HE, 100 x magnification. HE, 200 x magnification HE, 100 x magnification.
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case_images: f2
case_images: The maximum cross-sectional dimension of the target lesion measures approximately 117x130 mm ( Figures 1A ,  2A ). Considering the results of the ECT examination and the presence of bone metastasis, it indicates disease progression. ( Figures 1B ,  2B ).
case_images: Hematoxylin & eosin stain of tumor biopsy specimens in 2022.
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case_images: The postoperative pathology revealed: (Right axilla) Spindle cell proliferation with active growth, showing necrosis, nuclear division, and significant cellular atypia. ( Figure 3 ) Immunohistochemistry demonstrated CD21 (+), CD23 (-), CD68 (-), CK (-), Ki67 (15%+), Melan-A (-), P53 (+), S-100 (-), MLH1 (+), MSH2 (+), MSH6 (+), PD-1 (-), PD-L1 (approximately 30% positive in tumor cells), PMS2 (+), CXCL13(+) ( Figure 4 ).
case_images: Immunohistochemistry of tumor biopsy specimens on May 30, 2022. CD21(+),Ki-67(+),P53(+),CD23(-),CD68(-),CXCL13(+),PDL-1(+).
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case_images: f4
case_images: The postoperative pathology revealed: (Right axilla) Spindle cell proliferation with active growth, showing necrosis, nuclear division, and significant cellular atypia. ( Figure 3 ) Immunohistochemistry demonstrated CD21 (+), CD23 (-), CD68 (-), CK (-), Ki67 (15%+), Melan-A (-), P53 (+), S-100 (-), MLH1 (+), MSH2 (+), MSH6 (+), PD-1 (-), PD-L1 (approximately 30% positive in tumor cells), PMS2 (+), CXCL13(+) ( Figure 4 ).
case_images: The patient's treatment timeline.
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case_images: The entire treatment process is illustrated in the diagram ( Figure 5 ).