case_images: PMC9911421_01
case_images: (A) Esophagogastroduodenoscopy showing a very large irregular ulcerated tumor in the periampullary area. (B) Histopathology showing invasive moderately differentiated squamous cell carcinoma (hematoxylin and eosin staining, x200 magnification). (C) Expression of P40 (x200 magnification) and (D) cytokeratin (CK)5/6 detected by immunohistochemistry (x200 magnification). (E) Expression of programmed cell death-ligand 1 (PD-L1; x200 magnification) and (F) programmed cell death protein-1 (PD-1) detected by immunohistochemistry (x200 magnification).
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case_images: Esophagogastroduodenoscopy revealed a very large irregular ulcerated tumor with volcano-like changes around it in the periampullary area ( Figure 1A ). Six biopsy samples were obtained, all of which showed invasive moderately differentiated SCC ( Figure 1B ). Immunohistochemistry (IHC) revealed moderately positive expression of P40 and CK5/6 in SCC cells ( Figures 1C, D ). In addition, the PD-L1 expression level in tumor cells was 50%, and the programmed cell death protein 1 (PD-1) expression level in immune cells was 3% ( Figures 1E, F ).
case_images: (A) Abdominal contrast-enhanced computed tomography (CT) showed a mass approximately 5.8 x 4.7 cm in size in the periampullary area. (B) The largest lymph node in the retroperitoneal space was approximately 1.0 cm in size. (C) After treatment, abdominal enhanced CT showed shrinkage of the primary lesion. (D) The largest lymph node also shrank (red arrow).
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case_images: Contrast-enhanced CT of the abdomen showed a mass approximately 5.8 x 4.7 cm in size in the periampullary area ( Figure 2A ) and multiple enlarged retroperitoneal lymph nodes, the largest being approximately 1.0 cm in size ( Figure 2B ). 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT) from the skull base to mid-thigh showed a periampullary lesion with a delayed-phase standardized uptake value (SUV) of 13.5, with metastasis to multiple lymph nodes around the duodenum, retroperitoneal para-aortic nodes, mesenteric root, left supraclavicular fossa, and left thoracic entrance area (delayed-phase SUV of 5.0). No complications were observed, and the most recent chest and abdominal enhanced CT indicated that the primary lesion ( Figure 2C ) and metastasized lymph nodes in the retroperitoneal space ( Figure 2D ) had shrunk (partial response).
case_images: Carcinoembryonic antigen levels during treatment.
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case_images: Moreover, CEA fell to 3.08 ng/ml (normal value: <5.0 ng/ml) ( Figure 3 ).