case_images: PMC10809987_01
case_images: PET/CT shows multiple nodular and lump-like abnormal signal lesions under the liver surface, the larger one is located in the space between the liver and the right kidney, about 85 mm x 57 mm in size.
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case_images: F1
case_images: There were also multiple peritoneal implant metastases, and a possible metastasis next to the thoracic/dorsal 11th vertebra on the right side (Figure 1).
case_images: Some areas of MPM are arranged in nests and sheets, and some areas have glandular structure. This is a mid-power magnification of Hematoxylin and Eosin (HE) staining.
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case_images: F2
case_images: Some areas showed papillary and glandular structures, while other areas showed nest-like structures, accompanied by significant collagenization in the stroma, classified as biphasic type (Figures 2-4).
case_images: Necrosis can be seen in some areas of MPM in this mid-power magnification of HE staining.
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case_images: F3
case_images: Some areas showed papillary and glandular structures, while other areas showed nest-like structures, accompanied by significant collagenization in the stroma, classified as biphasic type (Figures 2-4).
case_images: The tumor cells are epitheliod and have abundant cytoplasm. This is a high-power magnification of HE staining.
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case_images: F4
case_images: Some areas showed papillary and glandular structures, while other areas showed nest-like structures, accompanied by significant collagenization in the stroma, classified as biphasic type (Figures 2-4).
case_images: The tumor cells diffusely express PD-L1 clone 288, a high-power magnification of the EnVision method.
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case_images: F5
case_images: PD-1 was positive in the stroma with abundant lymphocytes, while PD-L1 clone 28-8 was positive in tumor cells (70%) and negative in stromal cells. PD-L1 clone E1L3N was positive in tumor cells (70%) and negative in stromal cells. PDL1 clone 22C3 was positive in tumor cells (5%) and negative in stromal cells (Figures 5, 6).
case_images: The tumor cells diffusely express PD-L1 clone E1L3N, a high-power magnification of the EnVision method.
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case_images: F6
case_images: PD-1 was positive in the stroma with abundant lymphocytes, while PD-L1 clone 28-8 was positive in tumor cells (70%) and negative in stromal cells. PD-L1 clone E1L3N was positive in tumor cells (70%) and negative in stromal cells. PDL1 clone 22C3 was positive in tumor cells (5%) and negative in stromal cells (Figures 5, 6).
case_images: After six rounds of chemotherapy and four rounds of immunotherapy, the repeat CT showed uneven liver surface and the lesion in the liver-kidney space was significantly smaller than before.
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case_images: F7
case_images: CT scans showed a significant reduction in the size of the lesions compared to before (43 mm x 27 mm) (Figure 7).
case_images: After six rounds of chemotherapy and four rounds of immunotherapy, a total peritonectomy was performed, and possible nodules were seen on the cut surface of the liver.
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case_images: F8
case_images: During the operation, scattered thickened lesions and noticeable retraction were observed in the peritoneum (Figures 8, 9).
case_images: After six rounds of chemotherapy and four rounds of immunotherapy, a total peritonectomy was performed, and hard nodules were seen in the omental tissue.
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case_images: F9
case_images: During the operation, scattered thickened lesions and noticeable retraction were observed in the peritoneum (Figures 8, 9).
case_images: After six rounds of chemotherapy and four rounds of immunotherapy, the tumor regressed significantly, with a large amount of lymphocytic infiltration around the residual tumor cells. This is a high-power magnification of HE staining.
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case_images: F10
case_images: Based on the morphology and immunohistochemistry results, residual tumor cells were less than 5% and exhibited significant wrinkling and thinning (Figures 10, 11).
case_images: After six rounds of chemotherapy and four rounds of immunotherapy, the tumor regressed significantly, with significant collagenization in the lesion. This is a high-power magnification of HE staining.
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case_images: F11
case_images: Based on the morphology and immunohistochemistry results, residual tumor cells were less than 5% and exhibited significant wrinkling and thinning (Figures 10, 11).
case_images: After six rounds of chemotherapy and four rounds of immunotherapy, there was a small amount of lymphocytic infiltration in the lung interstitium, the alveolar septum was slightly widened, and there was a small amount of lymphocytic infiltration in the alveolar cavity, forming changes of organizing pneumonia. This is a high-power magnification of HE staining.
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case_images: F12
case_images: I (Figure 12). Immunotherapy was discontinued, and targeted treatment with olaparib was continued.