case_images: PMC10234503_01
case_images: Images of primary tumor and metastatic lymph nodes during therapy. (A) Initial scans showed a mass in the right tonsil (red circle). Enlarged lymph nodes in the neck and mediastinum (yellow arrows) (December 2020). (B) Disease progression after 2 cycles of chemotherapy by RECIST criterion (February 2021). (C) After bilateral external carotid artery branch embolization (March 2021). (D) Partial response after 2 cycles of niraparib and tislelizumab by RECIST criterion (May 2021). (E) Re-examination of MRI and CT revealed no evidence of progression to the tonsils, cervical lymph nodes, and mediastinal and hilar lymph nodes (May 31, 2022).
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case_images: Physical examination showed an exophytic yellow-white cauliflower-like mass on the surface of the right tonsil, partially extending beyond the midline, but not invading other tissues around the oropharynx ( Figure 1A ). Whole-body Positron Emission Tomography-Computed Tomography (PET/CT) (December 22, 2020) showed multiple enlarged lymph nodes in the mediastinum and hilum, with a maximum of 21 x 18 mm ( Figure 1A ). Chest CT showed multiple enlarged lymph nodes in the mediastinum and hilus, with a maximum of 29 mm x 23 mm ( Figure 1B ). After locoregional operation, the patient had only mild pain around the neck, the tonsil mass was reduced to 20x15 mm, and the largest cervical lymph nodes were 32 x 20 mm (right) and 27 x 17 mm (left) (March 25, 2021) ( Figure 1C ). The hilar lymph node was reduced to 20 x 14 mm ( Figure 1D ). Re-examination of MRI and CT revealed no evidence of progression to the tonsils, cervical lymph nodes, and mediastinal and hilar lymph nodes (May 31, 2022) ( Figure 1E ).
case_images: Pathological examination of the tonsil mass. (A) Hematoxylin-eosin (H&E) staining of the tonsil mass (x100). (B) PD-L1 expression by immunohistochemistry (90%+). (C) Ki-67 expression by immunohistochemistry (80%+). (D) CD138 expression by immunohistochemistry (partial +). (E) Vimentin expression by immunohistochemistry (+).
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case_images: The pathological results of the central laboratory were confirmed on March 5, 2021. Tonsil mass was demonstrated as malignancy by hematoxylin-eosin (H&E) staining which showed small foci of heterotypic tumor cells, some cells with light stained and obvious large nucleoli cell ( Figure 2A ).
case_images: Treatment timeline.
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case_images: Surveillance imaging showed continuous partial remission for 12 months ( Figure 3 ). The timeline of the relevant information is shown in  Figure 3 .
case_images: Colonoscopy and pathology of the colon mass. (A) Colonoscopy showed a mass in the ascending colon. (B) Hematoxylin-eosin (H&E) staining of the colon mass (x100).
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case_images: Colonoscopy revealed a mass in the ascending colon, accounting for about 2/3 of the intestinal lumen, with superficial fragility and hemorrhage ( Figure 4A ). Postoperative pathology showed that the colonic mass was metastatic undifferentiated tonsillar carcinoma, with no lymph node metastasis ( Figure 4B ).