PMC8580725_01
(a): Panoramic view of haematoxylin and eosin (H&E) stained sections of cystectomy specimen showing a highly infiltrative neoplasm through the vesical muscular wall (40x). (b): H&E high power view analysis of cystectomy (200x) with invasive carcinoma in muscular propria and intratumoral lymphocyte infiltration. (c): H&E analysis of metastatic lymph node with carcinoma (200x). (d): IHC with strong and diffuse positivity for PD-L1 22C3.
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figure1
After the last cycle, a radical cystoprostatectomy was performed and pathology showed a poor response to neoadjuvant chemotherapy (ypT3N2) (Figure 1).
(a): 18F-FDG PET/CT imaging baseline before the initial therapy with pembrolizumab, showing mesorectal and inferior mesenteric LN, measuring up to 1.7 cm (SUVmax: 7.9). Nucleus centred on the right sciatic foramen measuring 2.0 cm (SUVmax: 10.4), maintaining close contact with the sciatic roots on this side. (b): Restaging after seventh cycle demonstrating resolution of glycolytic hypermetabolism in those previous LN.
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figure2
A new image after the seventh cycle demonstrated a CR (Figure 2), which was sustained after 9 months of treatment.