case_images: PMC10582703_01
case_images: (A) Diagnosis and treatment timeline of the patient, with pre-treatment imaging highlighted in yellow, on treatment imaging highlighted in blue, and post-treatment imaging highlighted in green. (B) Pre-treatment PET scan showing FDG avid peripancreatic fluid collection and FGD avid pelvic soft tissue mass. (C) Pre-treatment CT scan showing peripancreatic nodule and redemonstrating pelvic soft tissue mass. (D) On-treatment CT scan showing partial response in peripancreatic and pelvic soft tissue masses. (E) Post-treatment CT scan demonstrating stable disease. (B-E) white arrows demonstrate highlighted areas of interest.
case_images: fonc-13-1271255-g001.jpg
case_images: PMC10582703_03_fonc-13-1271255-g001.jpg
case_images: f1
case_images: IV every 4 weeks and cabozantinib 40 mg PO daily. In May 2021, imaging demonstrated a partial response to therapy with resolution of the peri-pancreatic nodule and a reduction in the soft tissue mass in the pelvis ( Figure 1D ). Ultimately, the disease remained stable on cabozantinib 20 mg PO every other day ( Figure 1A ). In May 2023, the most recent imaging redemonstrated stable disease, maintaining partial response, and at the time of this report, the patient is alive and well ( Figure 1E ).
case_images: PMC10582703_02
case_images: (A) Diagnosis and treatment timeline of the patient, with pre-treatment imaging highlighted in yellow, on treatment imaging highlighted in blue, and post-treatment imaging highlighted in green. (B) Pre-treatment PET scan showing FDG avid peripancreatic fluid collection and FGD avid pelvic soft tissue mass. (C) Pre-treatment CT scan showing peripancreatic nodule and redemonstrating pelvic soft tissue mass. (D) On-treatment CT scan showing partial response in peripancreatic and pelvic soft tissue masses. (E) Post-treatment CT scan demonstrating stable disease. (B-E) white arrows demonstrate highlighted areas of interest.
case_images: fonc-13-1271255-g001.jpg
case_images: PMC10582703_03_fonc-13-1271255-g001.jpg
case_images: f1
case_images: IV every 4 weeks and cabozantinib 40 mg PO daily. In May 2021, imaging demonstrated a partial response to therapy with resolution of the peri-pancreatic nodule and a reduction in the soft tissue mass in the pelvis ( Figure 1D ). Ultimately, the disease remained stable on cabozantinib 20 mg PO every other day ( Figure 1A ). In May 2023, the most recent imaging redemonstrated stable disease, maintaining partial response, and at the time of this report, the patient is alive and well ( Figure 1E ).
case_images: Representative histopathology of extrarenal renal cell carcinoma, demonstrating clear cell renal cell carcinoma in the spleen. (A) Low power view of renal cell carcinoma within splenic parenchyma. (B) Solid nests of renal cell carcinoma with partially clear cytoplasm in a fibrotic stroma. (C) PAX-8 positivity of tumor cells, a pan real marker. (D) Carbonic anhydrase IX (CAIX) positivity of tumor cells. (E) Diffuse positivity for cytokeratin 7 amongst tumor cells. (F) Immunofluorescence staining demonstrating CK18+ tumor cells with infiltrating PD1+CD8+T- cells and PD1+TCF1+CD8+T-cells (white arrows).
case_images: fonc-13-1271255-g002.jpg
case_images: PMC10582703_02_fonc-13-1271255-g002.jpg
case_images: f2
case_images: At this time, additional staining of the pathology specimen displayed a morphologic and immunohistochemical profile consistent with a renal primary ( Figures 2A, B ), including positive detection of PAX8 and CK7 while being negative for CK20 ( Figures 2C-E ). The cells consisted of anaplastic-looking epithelioid cells in a background of lymphoid tissue, displaying pronounced nuclear pleomorphism and atypical mitotic figures, without sarcomatoid features ( Figure 2 ). Experimental (non-clinical) immunofluorescence staining was performed on the last biopsy specimen, for infiltrating immune cells, which revealed PD1+ CD8+T cells surrounding and infiltrating nests of CK18+ tumor cells ( Figure 2F ).
case_images: PMC10582703_03
case_images: (A) Diagnosis and treatment timeline of the patient, with pre-treatment imaging highlighted in yellow, on treatment imaging highlighted in blue, and post-treatment imaging highlighted in green. (B) Pre-treatment PET scan showing FDG avid peripancreatic fluid collection and FGD avid pelvic soft tissue mass. (C) Pre-treatment CT scan showing peripancreatic nodule and redemonstrating pelvic soft tissue mass. (D) On-treatment CT scan showing partial response in peripancreatic and pelvic soft tissue masses. (E) Post-treatment CT scan demonstrating stable disease. (B-E) white arrows demonstrate highlighted areas of interest.
case_images: fonc-13-1271255-g001.jpg
case_images: PMC10582703_03_fonc-13-1271255-g001.jpg
case_images: f1
case_images: IV every 4 weeks and cabozantinib 40 mg PO daily. In May 2021, imaging demonstrated a partial response to therapy with resolution of the peri-pancreatic nodule and a reduction in the soft tissue mass in the pelvis ( Figure 1D ). Ultimately, the disease remained stable on cabozantinib 20 mg PO every other day ( Figure 1A ). In May 2023, the most recent imaging redemonstrated stable disease, maintaining partial response, and at the time of this report, the patient is alive and well ( Figure 1E ).