case_images: PMC10665504_01
case_images: Pathological findings of post-operative biopsies. (A) HE staining revealed spindle cell morphology (10 x), IHC staining showed that lymphoma cells were positive for (B) desmin, (C) calponin, (D) caldesmon, (E) SMA, and (F) MIB1 and negative for (G) S100, (H) CR, (I) NF, (J) and SATB2, supporting the diagnosis. Original magnification: (A-J), 200 x.
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case_images: F1
case_images: The final pathology of the post-operative specimens suggested spindle cell morphology with immunohistochemical results being positive for desmin, calponin, caldesmon, SMA, and MIB1 and negative for S100, CR, NF, and SATB2 and confirmed the diagnosis of left femoral intertrochanteric leiomyosarcoma, grade III (FNCLCC) (Figure 1). Then, the number and size of bilateral pulmonary nodes increased, and the curative effect was evaluated as progression disease (PD) based on the RECIST criteria (Supplementary Figures S1E-H).
case_images: (A-C) Image evaluation after second-line treatment with eribulin for two cycles: progressive disease; (D-E) image evaluation after fourth-line treatment of penpulimab combined with lenvatinib in February 2022: progressive disease; (G-I) image evaluation after fourth-line treatment of penpulimab combined with lenvatinib in May 2022: dissociated response; and (J-L) image evaluation in November 2022: dissociated response.
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case_images: F2
case_images: However, the patient did not benefit from eribulin, with the disease being judged to progress after only two cycles (Figures 2A-C, 3F-J). A CT re-examination in February 2022 indicated that tumors had shrunk along with the absorption of the inflammatory exudation around the pancreas and the recession of the pancreatic pseudocyst, and the efficacy evaluation was partial response (PR) (Figures 2D-F, 3K-O). In August 2022, the previous new nodule of the lung continued to grow, but the rest of the lesions remained stable, which indicated immune-confirmed progressive disease (iCPD), with a pattern of dissociated response (DR) (Figures 2G-I, 3P-T). The latest imaging assessment in November 2022 revealed that all lesions were all reduced or stable, with the exception of a new metastasis in the right lobe of the liver (Figures 2J-L, 3U-Y).
case_images: (A-F) Image evaluation after second-line treatment of gemcitabine plus docetaxel in September 2021: progressive disease; (F-J) image evaluation after third-line treatment with eribulin for two cycles: progressive disease; (K-O) image evaluation after fourth-line treatment of penpulimab combined with lenvatinib in February 2022: progressive disease; (P-T) image evaluation after fourth-line treatment of penpulimab combined with lenvatinib in May 2022: dissociated response; and (U-Y) image evaluation in November 2022: dissociated response.
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case_images: F3
case_images: The follow-up imaginological examination revealed new metastases in bilateral erector spinae, left internal abdominal oblique muscle, L1 and L4 vertebra, and pancreas, along with acute necrotizing pancreatitis and pancreatic pseudocyst (Figures 3A-E). However, the patient did not benefit from eribulin, with the disease being judged to progress after only two cycles (Figures 2A-C, 3F-J). A CT re-examination in February 2022 indicated that tumors had shrunk along with the absorption of the inflammatory exudation around the pancreas and the recession of the pancreatic pseudocyst, and the efficacy evaluation was partial response (PR) (Figures 2D-F, 3K-O). In August 2022, the previous new nodule of the lung continued to grow, but the rest of the lesions remained stable, which indicated immune-confirmed progressive disease (iCPD), with a pattern of dissociated response (DR) (Figures 2G-I, 3P-T). The latest imaging assessment in November 2022 revealed that all lesions were all reduced or stable, with the exception of a new metastasis in the right lobe of the liver (Figures 2J-L, 3U-Y).
case_images: (A) Changes in serum amylase and lipase levels during the treatment; (B) treatment timeline of the patient with PLMSB.
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case_images: PMC10665504_01_fphar-14-1239699-g004.jpg
case_images: F4
case_images: At that time, the laboratory examination showed the abnormal elevation of serum amylase (up to 182 IU/L) and lipase (up to 325.4 IU/L) (Figure 4A). After broad-spectrum antibiotics and other supportive treatments, the patient's abdominal pain was significantly alleviated, and the levels of both serum amylase and lipase gradually declined but remained persistently above the normal reference range (Figure 4A). The level of serum amylase and lipase demonstrated a constant downward trend with complete normalization (14.39 U/mL) by the end of his six cycles of treatment (Figure 4A). In order to intuitively reflect the patient's prognosis and clinical curative effect, we listed the entire treatment process with timeline in Figure 4B.