case_images: PMC11080619_01
case_images: Histopathology and immunohistochemistry (IHC) of HNSC. (A, B) H&E stain, original magnification x100,x400. (C) IHC CK(pan)(+) original magnification x200. (D) IHC Vimentin(+), original magnification x200. (E) IHC GATA3(+) original magnification x20. (F) IHC Melan(+) original magnification x20. (G) PD-L1 IHC (Dako22C3), original magnification x40. Combined Positive Score [CPS]: 95. (CPS was defined as the number of PD-L1 stained cells (tumor cells, lymphocytes, macrophages) divided by the number of all tumor cells and multiplied by 100.).
case_images: fonc-14-1362160-g001.jpg
case_images: PMC11080619_01_fonc-14-1362160-g001.jpg
case_images: f1
case_images: PD-L1 was strongly expressed with a CPS was 95 ( Figure 1 ).
case_images: Imaging performance. (A, B) Eight months after the second surgery, the patient's PET/CT examination suggested tumor recurrence and metastasis with multiple lymph node metastases in the left side of the neck. (C-F) continuous shrinkage of the tumor lesion and metastatic lymph nodes following sintilimab combined with anlotinib treatment in October 2023, December 2023, respectively.
case_images: fonc-14-1362160-g002.jpg
case_images: PMC11080619_01_fonc-14-1362160-g002.jpg
case_images: f2
case_images: In July 2023, positron emission tomography (PET)/CT suggested multiple lymph node metastases in the left neck and axillary fossa; and inhomogeneous increase in 18F-fluorodeoxyglucose (18F-FDG) metabolism in the C2-C4 vertebrae and their surrounding soft tissues ( Figures 2A, B ). On October 18, 2023, an enhanced Computed tomography (CT) examination of the patient's neck suggested significant tumor reduction ( Figures 2C, D ), and the function of the thyroid was better than before. After 4 cycles, the tumor was further reduced and the clinical efficacy was evaluated PR ( Figures 2E, F ).
case_images: Timeline of treatment process.
case_images: fonc-14-1362160-g003.jpg
case_images: PMC11080619_01_fonc-14-1362160-g003.jpg
case_images: f3
case_images: The treatment timeline is shown in  Figure 3 .