case_images: PMC11331467_01
case_images: The pathological diagnosis of the patient. (The sample obtained this time was named FFPE-2017, which is convenient for interpretation in subsequent detection results).
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case_images: Calretinin (+), WT-1 (+-), and D2-40 (+) suggested malignant mesothelioma, CDX-2 (-) excluded tumors from the digestive tract, and ER (-) excluded breast metastases. Combined with immunohistochemistry and clinical findings, the patient was diagnosed with malignant mesothelioma (Figure 2).
case_images: CT image of the patient. (a)-(d) are the imaging findings of patients on October 10, 2017, February 19, 2020, October 9, 2020, and February 24, 2021, respectively; ((a)-(d) all show varying degrees of disease progression; The samples obtained by (b) and (d) were named FFPE-2020 and FFPE-2021).
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case_images: Clinical efficacy evaluation in October 2017 suggested disease progression, with increased ascites, local thickening of the peritoneum, and turbidity in the fat space of the mesentery (Figure 3(a)). Due to poor efficacy, laparoscopic peritoneal mesothelioma resection was performed on May 8, 2020, the peritoneal lesions were removed, and pathological examination was performed (Figure 3(b)). The re-examination on February 24, 2021 indicated that the tuberculum of the anterior hepatis was significantly larger than that of October 2020 (Figure 3(c) and (d)).
case_images: Similarity among different lesions based on somatic mutation analysis. (a) Venn diagram illustrating the distributions of genetic mutation in different lesions. (b) Venn diagram illustrating the distributions of driver genetic mutation in different lesions.
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case_images: A total of 230, 226, and 193 somatic gene variations were identified in the primary and anterior and posterior recurrence foci respectively, among which there were 12, 15, and 9 driver genetic mutations respectively (Figure 4).
case_images: Statistics of different types of point mutations. (a) Statistical map of point mutation types. (b) Statistical map of mutation patterns in all samples.
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case_images: In addition, statistical analysis of the base replacement characteristics of somatic cells at different stages in tumor tissue samples found differences, in which the primary focus was strongly enriched in A>G, G>C, and T>C, while the base replacement of the recurrent focus was doubled to C>A (Figure 5).
case_images: Tumor evolutionary tree.
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case_images: It was suggested that there were large commonalities and small differences among subclones within recurrent tumors (Figure 6).