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case_images: Abdominal CT before and after treatment. (A-C) (November 24th, 2021) A baseline abdominal computed tomography (CT) scan before treatment. (D-F) (January19th, 2022) After "bevacizumab + albumin-bound paclitaxel + Cisplatin" treatment was given for 2 cycles. (G-I) (April21th, 2022) After "bevacizumab + albumin-bound paclitaxel + Cisplatin" treatment was given for 5 cycles. (J-L) (May8th, 2023) After "Oral anlotinib maintenance therapy" was given for 12.5 months.
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case_images: A baseline abdominal computed tomography (CT) (Figure 1A-C) examination of the patient revealed a large amount of fluid in the abdomen, cystic and solid mixed density masses in the perihepatic, intraperitoneal, pelvic, retroperitoneal, and bilateral adnexal areas, which were significantly enhanced after enhanced scanning, while the peritoneum was diffuse and thickened, and part of the greater omentum was cake shaped. CT reexamination after two cycles of treatment showed that ascites disappeared, abdominal and pelvic masses were significantly reduced, and we judged the efficacy as partial remission (PR) (Figure 1D-F). CT reexamination after 5 cycles showed that the efficacy remained PR (Figure 1G-I) and CA125 8 u/mL. Therefore, treatment with oral anlotinib [10 mg once a day (qd) on days 1-14 every 3wk] was administrated on April 25, 2022.Regular follow-up during maintenance treatment, multiple CT reviews showed that the intraperitoneal lesions remained stable, and the overall evaluation was stable disease (SD) (Figure 1J-L).
case_images: Histopathological staining and Immunohistochemical stain of peritoneal surface nodules. (A) hematoxylin and eosin stain. Magnification: x 200; (B-E) Immunohistochemical stain: (B) CK5/6(+); (C) HBME1(+); (D) Vim (+); (E) WT-1(1% weak +); (200X).
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case_images: Postoperative pathology (Figure 2A) showed (peritoneum)malignant tumor. Immunohistochemical results (Figure 2B-E) showed CK5/6 (+), Calretinin (-), HBME1 (+), PAX - 8 (+), P53 (+ 80%), WT - 1 (Scattered +), CEA (-), D2-40 (-), ER (+ 80%), Vim (+), Combined with histological findings, the patient was eventually diagnosed with malignant peritoneal mesothelioma (mainly epithelial differentiation).
case_images: Dynamic evolution of CA125 during the course of disease.
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case_images: It had been stable for a while, but it seemed to be on the rise recently (Figure 3).