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case_images: PET/CT images or pathology of primary and metastatic tumor. (A) PET/CT showing a gallbladder malignant tumor with multiple lymph node metastases. (B) The histopathology of gallbladder mass biopsy indicating gallbladder adenocarcinoma. (C) The result of IHC showing a positive expression of PD-L1.
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case_images: The positron emission tomography/computed tomography (PET/CT) examination revealed a gallbladder malignant tumor with lymph node metastasis in the left supraclavicular fossa, hepatic hilum, hepato-gastric space, retroperitoneum, abdominal cavity, and right pelvic cavity (Figure 1A). The histopathology of cystic mass biopsy guided by ultrasound showed a gallbladder adenocarcinoma with metastases in multiple lymph nodes at stage IVB (cT3N2M1) (Figure 1B). However, the immunohistochemistry (IHC) indicated that the PD-L1 expression of the tumor was positive (TPS 30%) (Figure 1C).
case_images: Radiological imaging studies and electronic gastroduodenoscopy showing progression of disease. (A) CT scan revealed that the gallbladder tumor lesion was larger than before and more lymph node metastases. (B) Upper gastrointestinal radiography showed obstruction at the origin of the horizontal part of the duodenum. (C) Electronic gastroduodenoscopy showed stenosis of the horizontal transition of the duodenum.
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case_images: U/mL (normal range, <35 U/mL). Computed tomography (CT) revealed that the gallbladder tumor was larger than before and had multiple peritoneal, intra-abdominal, retroperitoneal, and mesenteric lymph node metastases, suggesting progression of the disease (Figure 2A). Upper gastrointestinal radiography showed obstruction at the origin of the horizontal part of the duodenum (Figure 2B). Electronic gastroduodenoscopy showed stenosis of the horizontal transition of the duodenum (Figure 2C).
case_images: Electronic gastroduodenoscopy showing no significant stenosis in the duodenum.
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case_images: After a complete course, the patient felt better, and repeat gastroscopy showed no significant stenosis in the descending part of the duodenum (Figure 3).
case_images: CT scans show the therapeutic response of patients following a series of treatment.
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case_images: Surprisingly, after two courses, CT on February 19, 2021 showed a significant shrinkage of primary lesions and metastatic lymph nodes (Figure 4). Six courses later, we delightfully noticed that the patient's gall bladder lesions were reduced further, and abdominal lymph nodes were significantly reduced and decreased (Figure 4).
case_images: CT scan shows the tumor in gall bladder and metastatic lymph nodes on December 31, 2021.
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case_images: Recent imaging was performed on December 31, 2021 (Figure 5) and tumor lesions were stable.
case_images: The timeline of the process of development and treatment of the patient.
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case_images: Figure 6 shows the process of development and treatment of the disease.