case_images: PMC7307284_01
case_images: Moderately differentiated tumour with focal glandular pattern, associated with a dense
  peritumoural lymphocyte-rich stroma (hemtoxylene eosin and safran x 100). (b) Diffuse
  expression of cytokeratine 7. (c) Focal positivity with glypican 3 antibody. (d) Strong
  and diffuse staining for programmed death-ligand 1.
case_images: 10.1177_1756284820935189-fig1.jpg
case_images: PMC7307284_01_10.1177_1756284820935189-fig1.jpg
case_images: fig1-1756284820935189
case_images: The cytokeratine 7 antibody marked the glandular regions and cytokeratine 19 and glypican 3 markers were positive (Figure 1(a)-(c)). In the absence of a validated treatment option in a patient presenting tumour progression after two lines of treatment, a further complementary immunohistochemical evaluation of his PD-L1 status was requested, which showed 85% labelling of the tumour cells (Figure 1(d)).
case_images: PET scan performed in July 2018 (baseline) showing liver and lymph-node involvement.
  (b) PET scan performed in October 2018 following four injections of pembrolizumab
  showing partial response at the supra- and sub-diaphragmatic targets.. PET, positron emission tomography.
case_images: 10.1177_1756284820935189-fig2.jpg
case_images: PMC7307284_01_10.1177_1756284820935189-fig2.jpg
case_images: fig2-1756284820935189
case_images: The first PET scan reassessment performed in October 2018 after three injections of pembrolizumab revealed the normalisation of the voluminous liver and lymph nodes fixations with the exception of the pre-vena cava adenopathy, which showed a clear reduction of fixation (28.6 mm/SUV 3.6 (standardized uptake value) versus 47 mm/SUV 18) (Figure 2).
case_images: PET scan performed in January 2020 showing maintenance of complete tumour response
  after 18 months of treatment with pembrolizumab.. PET, positron emission tomography.
case_images: 10.1177_1756284820935189-fig3.jpg
case_images: PMC7307284_01_10.1177_1756284820935189-fig3.jpg
case_images: fig3-1756284820935189
case_images: The latest PET scan in January 2020 indicated continuing tumour control and excellent clinical and biological tolerance (Figure 3).