PMC9049212_01
Serial axial computed contrast-enhanced computed tomography (CT) images of the upper abdomen demonstrate (A) a left adrenal mass (circle) 4 months before admission and prior to treatment, (B) decreased tumor size by more than 50% (circle) as well as new-onset ascites and soft tissue edema (asterisks) at the time of hospital admission following therapy with combination immune checkpoint inhibitor therapy; (C) resolution of ascites and soft tissue edema and continued tumor response (circle) 8 months after admission. The patient was not receiving therapy at the time of the follow-up CT.
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A 70-year-old Caucasian male patient with widespread metastatic melanoma ( Figure 1A ) was initiated on first-line nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) administered every 3 weeks. CT imaging of the chest, abdomen, and pelvis demonstrated continued tumor control although new bilateral ground-glass opacities (GGOs) and pleural effusions were noted, as well as diffuse soft tissue edema and ascites in the abdomen and pelvis ( Figure 1B ). Subsequent CT scan ( Figure 1C ) demonstrated persistent disease control and resolution of volume overload.
(A) H&E-stained slide (x10) of duodenal biopsy demonstrating marked villous blunting, crypt hyperplasia, and expansion of lamina propria by lymphocytes and plasma cells. (B) H&E-stained slide (x10) of duodenal biopsy highlights the marked intraepithelial lymphocytosis (circled) without evidence of epithelial injury or neutrophils.
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Duodenal biopsies demonstrated marked villous blunting, intraepithelial lymphocytosis, and expansion of lamina propria ( Figure 2 ).