case_images: PMC10359695_01
case_images: Histological findings of invasive ductal carcinoma with programmed death-ligand 1 (PD-L1) positivity. a Hematoxylin and eosin staining showing invasive ductal carcinoma. b, c Immunohistochemistry images showing expression of PD-L1. b PD-L1 (clone 22C3). c PD-L1 (clone SP142).
case_images: cro-2023-0016-0001-530131_F01.jpg
case_images: PMC10359695_01_cro-2023-0016-0001-530131_F01.jpg
case_images: F1
case_images: The combined positive score for PD-L1 (clone 22C3) expression was 30%, and PD-L1 (clone SP142) expression on tumor-infiltrating immune cells as a percentage of tumor area accounted for 10% (Fig. 1).
case_images: Positron emission tomography/computed tomography image showing multiple lung metastases, pleural dissemination, pleural effusion, and supraclavicular node metastasis. The arrow indicates the supraclavicular node metastasis.
case_images: cro-2023-0016-0001-530131_F02.jpg
case_images: PMC10359695_01_cro-2023-0016-0001-530131_F02.jpg
case_images: F2
case_images: Five and a half years after the left breast surgery, positron emission tomography/computed tomography revealed multiple lung metastases, pleural dissemination, pleural effusion, and supraclavicular node metastasis (Fig. 2).
case_images: Changes in the levels of cancer antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA) from the first-line treatment to the end of the third-line treatment.
case_images: cro-2023-0016-0001-530131_F03.jpg
case_images: PMC10359695_01_cro-2023-0016-0001-530131_F03.jpg
case_images: F3
case_images: Computed tomography revealed disease progression (Fig. 3, 4a, b). Two cycles of pembrolizumab, gemcitabine, and carboplatin were administered as third-line therapy; however, the CA15-3 level rose rapidly and computed tomography revealed the growth of liver metastasis, suggesting that the treatment failed (Fig. 3, 4d).
case_images: Computed tomography images showing lung metastases, pleural dissemination, pleural effusion, and liver metastasis during the course of treatments. a Before the administration of atezolizumab plus nab-paclitaxel. b After 4 months of treatment with atezolizumab plus nab-paclitaxel. c After 4 months of treatment with olaparib. d After 2 months of treatment with pembrolizumab plus gemcitabine plus carboplatin. The arrow indicates liver metastasis.
case_images: cro-2023-0016-0001-530131_F04.jpg
case_images: PMC10359695_01_cro-2023-0016-0001-530131_F04.jpg
case_images: F4
case_images: Computed tomography revealed disease progression (Fig. 3, 4a, b). However, the CA15-3 level increased again and liver metastasis was found 4 months after the administration, although pleural effusion had subsided (Fig. 4c). Two cycles of pembrolizumab, gemcitabine, and carboplatin were administered as third-line therapy; however, the CA15-3 level rose rapidly and computed tomography revealed the growth of liver metastasis, suggesting that the treatment failed (Fig. 3, 4d).