PMC8791849_01
(A) Representative pathological image of gastric mass magnifications shows intense infiltrate of lymphocytes within the primary tumor (hematoxylin and eosin). (B) The brown cells in EBER-ISH x200 magnification images are the cells harboring EBV infection (EBV-encoded small RNA in situ hybridization, EBER-ISH). (C) Immunohistochemical staining indicated broadly positive programmed death-ligand 1 (PD-L1) expression in the primary tumor. (D-G) Multiplex immunohistochemical analysis from a variety of cells in the tumor microenvironment. (D) PD-L1+ cells (orange). (E) PD-1+ cells (purple). (F) CD8+T cells (green). (G) PD-L1+ CD68+ macrophages (yellow). Original magnification x200.
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Pathohistological results of distal gastric cancer resection showed that the tumor was poorly differentiated adenocarcinoma with lymphoid stroma component ( Figure 1 ), without any cancer in the surgical margin and metastasis to regional lymph nodes. An EBV-encoded RNA (EBER) assay demonstrated strong positive staining parallel to the tumor harboring EBV infection ( Figure 1 ). Immunohistochemical (IHC) data of the tumor tissue suggested that the positive expression of PD-L1 protein and the tumor proportion score (TPS) was 70% and the combined positive score (CPS) was 75 ( Figure 1 ).
(A) CT image presented lymph node metastasis before treatment. (B) CT image showed early tumor shrinkage to PR after two cycles' treatment. (C) CT image showed that lymph node metastasis was smaller (sustained PR) after four cycles. (D-F) CT and PET/CT images indicated lymph node metastasis with decrease >80% in size and mild uptake on 18F-FDG-PET/CT after seven cycles' SOX + camrelizumab and three cycles' S-1 + camrelizumab (total ten cycles). White arrows: lymph node metastasis.
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Table 2 ). Two months after the operation, abdominal CT showed enlargement of mass located in the gastrocolic ligament ( Figure 2 ), which indicated metastatic lymph node (LN). Figure 2 ). From then on, she had been exposed to SOX combined with camrelizumab up to 8 months and still achieved continuous PR. Tumor is gradually and continuously shrinking in the latest visit and in deep response with a >80% decrease in size ( Figure 2 ).