case_images: PMC10884146_01
case_images: Biopsy and pathology examination of gastric and axillary LNs before chemotherapy. (A) Hematoxylin-eosin staining pictures of the gastric (left) and axillary LNs (right) demonstrated adenocarcinoma, indicating that LN was a metastasis of GC. (B) Immunohistochemical staining indicated gastric tumor tissue expressed PD-L1. (C) Immunohistochemical staining showed gastric tumor tissue expressed CD8. (D) Immunohistochemical staining showed gastric tumor tissue expressed EBV.
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case_images: The patient was diagnosed as gastric poorly differentiated adenocarcinoma by gastroscopy and pathological examinations (Figure 1A). Biopsy of left axillary LN showed metastatic adenocarcinoma of gastric origin (Figure 1A). T-cell lymphoma and Epstein-Barr virus (EBV) positive in gastric tissue (Figures 1B-D). The immunostaining for human epidermal growth factor Type 2 (HER2) was negative and microsatellite instability (MSI) tests indicated microsatellite stability (MSS).
case_images: Enhanced abdominal CT during the follow-up period. (A) Baseline of first-line treatment: perigastric LNs (up); axillary LNs (down). (B) After six cycles of first-line treatment: perigastric LNs (up); axillary LNs (down). (C) Baseline of second-line treatment: retroperitoneal LNs (up); pelvic LNs (down). (D) After 23 cycles of second-line treatment: retroperitoneal LNs (up); pelvic LNs (down). The red circles represent the target lesion.
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case_images: The best effect was partial response (PR) which is reflected in the reduction of hepatic hilar and parietal LN metastases (Figure 2). The best curative effect was PR (Figure 2).
case_images: Biopsy and pathology examination of left supraclavicular LNs before chemotherapy after second-line treatment progresses. (A) Hematoxylin-eosin staining pictures of left supraclavicular LNs. (B) Immunohistochemical staining showed left supraclavicular LNs expressed PD-L1. (C) Immunohistochemical staining showed left supraclavicular LNs expressed CD8. (D) Immunohistochemical staining showed left supraclavicular LNs expressed CD3.
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case_images: The biopsy of left supraclavicular LN showed metastatic gastric adenocarcinoma (Figure 3A). CPS was 65 (Figure 3B).
case_images: Timeline of the treatment of this patient.
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case_images: The patient's overall survival has now reached 37 months (Figure 4).