case_images: PMC11220291_01
case_images: Immunohistochemical (IHC) and next-generation sequencing analysis of tumor tissue. (A) Representative microphotographs for hematoxylin and eosin (HE) staining and selected examples of IHC analysis (positive staining for CK7, and negative staining for TTF1 and GATA3); (B) the alignments of sequencing reads at the position of the NRAS p.Q61R mutation as shown in the IGV browser (version 2.16.1)
case_images: etat-05-1002246-g001.jpg
case_images: PMC11220291_01_etat-05-1002246-g001.jpg
case_images: fig1
case_images: CK7, but negative for CDX-2, CK20, GATA3, PAX8, and TTF1 (Figure 1A). Consequently, this malignancy was classified as a well-differentiated iCCA (large duct type). HER2, FGFR1-3, and KRAS genes. However, NRAS p.Q61R mutation was identified (Figure 1B).
case_images: The target lesion located in the S1 + 2 of the left lung (marked by red arrows) decreased in size by 50% after 2 months of therapy with trametinib, hydroxychloroquine, and bevacizumab [from 18 mm (A) to 9 mm (B)]. Non-target lesions (marked by blue arrows) were detectable at baseline (A), but absent in the follow-up scan (B). The examination of the supradiaphragmatic lymph nodes showed their reduction from 18 mm (C) to 9 mm (D) during the therapy (a decrease of 50%)
case_images: etat-05-1002246-g002.jpg
case_images: PMC11220291_01_etat-05-1002246-g002.jpg
case_images: fig2
case_images: On February 21st, 2023, a follow-up CT revealed a decrease in the number and size of metastatic lesions in the lungs, particularly a reduction of the lesion located at the S1 + 2 of the left lung [from 18 mm x 17 mm (Figure 2A) to 9 mm x 8 mm (Figure 2B)]. The size of the supradiaphragmatic lymph node decreased from 39 mm x 18 mm (Figure 2C) to 20 mm x 9 mm (Figure 2D).
case_images: Contrast-enhanced abdominal computed tomography (CT) scans were performed at baseline (left) and after 2 months of the triple-agent therapy (right). The treatment led to a reduction in the size of the following lesions (marked by red arrows): the tumor located in S4 of the liver [from 147 mm (A) to 115 mm (B); a decrease of 22%], the lesion in S8 of the liver [from 20 mm (C) to 17 mm (D); a decrease of 15%], and the conglomerate between the head of the pancreas and the inferior vena cava [from 42 mm (E) to 35 mm (F); a decrease of 17%]
case_images: etat-05-1002246-g003.jpg
case_images: PMC11220291_01_etat-05-1002246-g003.jpg
case_images: fig3
case_images: Tumor shrinkage was also observed in the liver: the lesion in S4, spreading to S8 and S2, was reduced in size from 147 mm x 89 mm (Figure 3A) to 115 mm x 65 mm (Figure 3B), and the lump located in S8 shrank from 20 mm x 20 mm (Figure 3C) to 17 mm x 15 mm (Figure 3D). There was also a reduction of the conglomerate located between the head of the pancreas and the inferior vena cava from 42 mm x 40 mm (Figure 3E) to 35 mm x 20 mm (Figure 3F).