case_images: PMC11263966_01
case_images: On 23 May 2019, the patient was started on 240 mg of nivolumab every 14 days. As the patient tolerated the treatment well, from the fourth cycle onwards, a 1 mg/kg dose of ipilimumab was added every 21 days. A significant partial response was observed in the PET-CT scan performed on 19 August 2019, after 6 cycles of nivolumab and 2 cycles of ipilimumab.
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case_images: PMC11263966_01_fmed-11-1403056-g001.jpg
case_images: fig1
case_images: The PET-CT scan, 3 months later, revealed a significant partial response (Figure 1).
case_images: PMC11263966_02
case_images: PET-CT: The PET-CT imaging dated 18 May 2023 indicates a suspicion of leptomeningeal disease characterized by diffuse, non-homogeneous hypermetabolic activity within the anterior, inferior, and medial regions of the right frontal lobe. This pattern of uptake is atypical and suggests a possible pathological process affecting the leptomeninges in these regions of the cerebral cortex, a novel finding as depicted in the figure provided.
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case_images: fig2
case_images: The PET-CT scan on 18 May 2023 showed a new finding that was suspected to be leptomeningeal involvement due to diffuse, non-homogeneous hypermetabolism observed in the anterior, inferior, and medial regions of the right frontal lobe (Figure 2).
case_images: Cranial MRI showing progression.
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case_images: PMC11263966_02_fmed-11-1403056-g003.jpg
case_images: fig3
case_images: However, the cranial MRI scan after 4 cycles of this treatment showed progression (Figure 3).