case_images: PMC10867321_01
case_images: Imaging examination before and after treatment. (A) Preoperative CT images of cardiac lesions and postoperative anastomosis. (B) Preoperative and postoperative CT images of the left liver lobe (C) right liver lobe and (D) portal vein. (E) Positron emission tomography/computed tomography scan after six cycles of treatment. Preoperative examination (2022/3/25), postoperative examination (2022/6/7), after 3 cycles of treatment (2022/9/11), after 6 cycles of treatment (2022/12/13), last follow-up (2023/3/3). Immunohistochemical staining of gastric MiNEN. (F) Hematoxylin and eosin staining. (G) Immunohistochemistry of PD-L1. Multiple immunofluorescences of gastric MiNEN. Analysis of the tumor microenvironment including PD-1, PD-L1, T cells, tumor-associated macrophages, and natural killer cells was performed. The merging of fluorescence signals is shown. (H) Representative immunofluorescence staining for PD-1 (green), PD-L1 (yellow), CD8 (pink), CD68 (cyan) and CD163 (red). (I) Representative immunofluorescence staining for CD3 (pink), CD4 (red), CD20 (green), CD56 (cyan) and FoxP3 (yellow). (J) Changes in circulating tumor cells before and after treatment.
case_images: fphar-15-1295134-g001.jpg
case_images: PMC10867321_01_fphar-15-1295134-g001.jpg
case_images: F1
case_images: An abdominal computed tomography (CT) scan showed uneven thickening of the cardia (Figure 1A). MiNEN (Figure 1F), of which approximately 50% were large cell neuroendocrine carcinomas, 45% were poorly differentiated adenocarcinomas, and approximately 5% were squamous cell carcinomas. Moreover, nineteen lymph nodes were examined, with one node showing lymphatic metastasis and another node showing a gastrointestinal stromal tumor (very low risk). Approximately 2 months after surgery, a CT scan revealed liver metastasis (Figure 1B&C) with portal vein thrombosis (Figure 1D). The results of the PD-L1 IHC 22C3 assay showed that the tumor proportion score (TPS) was 5% and the combined positive score (CPS) was 10 (Figure 1G). IF PD-L1 (E1L3N) assay showed TPS <1% and CPS <1. In addition, the composition of immune cells in the TME was determined by IF analysis, and the results (Figure 1H&I) showed CD3+, CD4+, and CD8+ T cell infiltration in the tumor parenchyma and stroma (5.09% vs 14.94%, 0.35% vs 0.52%, 0.66% vs 0.30%, respectively). After six cycles, both CT and positron emission tomography/computed tomography (PET/CT) scans showed complete regression of tumor lesions (Figure 1E). In addition, the number of CTCs was significantly reduced compared with the pre-treatment level (Figure 1J).