PMC9880206_01
(A)The hematoxylin-eosin (H&E) staining in the microscopic observation (20x) showing tumor cells with consistent morphology and size, spindle-shaped nuclei, and a high nucleus to cytoplasm ratio. Flexner-Wintersteiner rosettes can be seen. (B) Ki-67 staining in the microscopic observation (20x).
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The surgical procedure was successful, and the postoperative pathology confirmed ONB with 90% Ki-67 ( Figure 1 ).
(A) Timeline depicting diagnoses, changes in treatment, duration, and outcome. (B) MRI at the time admitted to our hospital. (C) MRI when achieving the PR. (D) MRI at PD. (E) MRI when reaching SD.
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The MRI revealed abnormal signals in the front lobe, nasal cavity, cervical spinal cord, upper thoracic spinal cord, and lumbar spinal cord ( Figure 2B ). Based on these findings, the patient received two cycles of intrathecal MTX injection (10mg, day1, 4, 6) and the intravenous ICE regimen (isocyclophosphamide 1.5g day1-3, etoposide 100mg day1-3, cisplatin 30mg day1-3) since July 2020 ( Figure 2A ). In October 2020, her brain and spine lesions shrunk by >= 30% ( Figure 2C ), and in December 2020, her CSF test showed no tumor cells ( Figure 3B ). The MRI showed that the intracranial lesion increased by over 20%, along with cerebral edema ( Figure 2D ). Thus, based on these results and the MRI findings ( Figure 2E ), we determined that she reached stable disease (SD).
(A) Morphological testing of CSF. (B) Percentage of tumor cells in cerebrospinal fluid and its correspondence with therapeutic protocols. (C) Percentage of T cells in serum and its correspondence with various treatment regimens.
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Correspondingly, the CSF test showing the presence of tumor cells (7%) confirmed the progression of the LM ( Figure 3A ). In October 2020, her brain and spine lesions shrunk by >= 30% ( Figure 2C ), and in December 2020, her CSF test showed no tumor cells ( Figure 3B ). T cells and T helper cells with killing functions increased. The proportion of the Ts cells, which suppress T cells, decreased, further indicating that the treatment had a good regulatory effect on the T cell population( Figure 3C ). There was also an increase in the percentage of tumor cells in the CSF ( Figure 3B ).