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case_images: Pathologic findings of the primary tumor and the pulmonary lesion specimen after trastuzumab-based therapy. (A) Hematoxylin and eosin staining of the primary tumor revealed bladder adenocarcinoma (magnification x200). (B) Hematoxylin and eosin staining of the pulmonary lesion specimen after trastuzumab-based therapy revealed adenocarcinoma, indicating that it was a metastasis of bladder adenocarcinoma (magnification x200). (C) The primary tumor exhibited strong positive immunohistochemical staining for HER2 (3+) (magnification x200). (D) The pulmonary lesion specimen after trastuzumab-based therapy exhibited positive immunohistochemical staining for HER2 (2+) (magnification x200).
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case_images: The pathological diagnosis was bladder adenocarcinoma (Figure 1A), with immunohistochemistry (IHC) showing CK7 (+), CK20 (+), CDX2 (+), GATA-3 (+-), LI-cad (+), PSA (-), P63 (-), P53 (+), HER2 (3+), and the Ki-67 proliferation index was 80% (Figure 1C). Pathological and histopathological examination revealed metastasis of bladder adenocarcinoma (Figure 1B), with IHC showing HER2 (2+) (Figure 1D).
case_images: Chest CT scans before and after trastuzumab-based therapy. (A) Before trastuzumab-based therapy (March 30, 2018), a CT scan showed a lesion in the left lower lung lobe (white arrow). (B) The disease reached partial remission after 2 cycles of trastuzumab-based treatment (May 25, 2018), the mass was reduced significantly (white arrow). (C) Disease progression after trastuzumab-based therapy for six months, enlargement of the mass (white arrow) was observed on October 23, 2018.
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case_images: The CT scan revealed progressed disease (PD), with new lesions identified on March 30, 2018 (Figure 2A). Tumors (RECIST) (version 1.1) and confirmed two months later. Trastuzumab-based therapy was continued for 8 cycles until CT scans revealed enlargement of the lesions (Figure 2C), with a PFS period of 6 months.
case_images: Analysis results from the STRING website. (A) Relationship of seven mutant genes before trastuzumab-based therapy. (B) Relationship of five mutant genes after trastuzumab-based therapy.
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case_images: The gene correlation analysis is shown in Figure 3.