case_images: PMC8200151_01
case_images: Gastroscopy, cystoscopy and histopathological results of the patient. (A) Gastroscopy revealed an 4cm x 1.5cm ulcerative lesion in the gastric horn. (B) Histopathologic diagnosis was gastric adenocarcinoma, signet ring cell carcinoma can be seen microscopically. (C) In Situ Hybridization (FISH) showed HER2 amplification. (D and E) Cystoscopy revealed multiple bladder masses. (F) Histopathologic diagnosis was urothelial carcinoma.
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case_images: Gastroscopy revealed an ulcerative lesion (4 cm x 1.5 cm) of gastric horn (Figure 1A), diagnosed as gastric adenocarcinoma. HER2 (2+). HER2 amplification was also evident by fluorescence in situ hybridization (Figure 1C); multiple enlarged and fused tumor-bearing lymph nodes appeared in computed tomography (CT) of the abdomen, rimming the stomach (Figure 3A and B). Cystoscopy and abdomen CT also disclosed multiple bladder tumors (Figure 1D and E) (Figure 3C) histologically confirmed as urothelial carcinoma (Figure 1F).
case_images: Immunohistochemical results of the patient. (A) MLH1 (+). (B) MSH2 (+). (C) MSH6 (+). (D) PMS2 (+). (E) PD-L1 (-) for gastric cancer. (F) PD-L1 (-) for bladder cancer.
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case_images: Abdominal CT images of the patient. (A and B) Abdominal CT images at initial diagnosis indicated multiple enlarged lymph node metastases around the stomach. (C) Abdominal CT images at initial diagnosis indicated multiple bladder tumors. (D and E) Abdominal CT images after 2 cycles of chemotherapy indicated multiple enlarged lymph node metastases around the stomach were smaller. (F) Abdominal CT images indicated new tumor in bladder and a recurrence of bladder cancer was considered. (G and H) Abdominal CT scan after 8 cycles of immunotherapy plus targeted therapy showed a significant reduction and shrinkage of metastatic lymph nodes around the stomach which suggested a partial response of the gastric cancer. (I) Abdominal CT scan showed the recrudescent bladder cancer was significantly shrunk after 8 cycles of immunotherapy plus targeted therapy.
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case_images: HER2 (2+). HER2 amplification was also evident by fluorescence in situ hybridization (Figure 1C); multiple enlarged and fused tumor-bearing lymph nodes appeared in computed tomography (CT) of the abdomen, rimming the stomach (Figure 3A and B). Cystoscopy and abdomen CT also disclosed multiple bladder tumors (Figure 1D and E) (Figure 3C) histologically confirmed as urothelial carcinoma (Figure 1F). CEA and CA-724 levels were decreased during this time (Figure 4A and B), abdominal CT for gastric cancer showed some shrinkage of the enlarged perigastric lymph nodes (Figure 3D and E). However, abdominal CT indicated new tumor in bladder and a recurrence of bladder cancer was considered (Figure 3F). After eight cycles of immunotherapy, abdominal CT showed a significant reduction and shrinkage of metastatic lymph nodes around the stomach which suggested a partial response of the gastric cancer (Figure 3G and H). CT also confirmed the recrudescent bladder cancer was significantly shrunk (Figure 3I). CEA and CA-724 levels were also decreased (Figure 4A and B), and the patient's quality of life improved substantially.
case_images: Cancer CEA (ng/mL) and CA-724 (U/mL) levels of the patient. (A) CEA levels during entire treatment. (B) CA-724 levels during entire treatment.
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case_images: CEA and CA-724 levels were decreased during this time (Figure 4A and B), abdominal CT for gastric cancer showed some shrinkage of the enlarged perigastric lymph nodes (Figure 3D and E). CT also confirmed the recrudescent bladder cancer was significantly shrunk (Figure 3I). CEA and CA-724 levels were also decreased (Figure 4A and B), and the patient's quality of life improved substantially.