PMC9650638_01
Hematoxylin & eosin (HE) and immunohistochemical (IHC) staining for the lesions. (A, B) HE staining (200x and 400x) of the primary solid pseudopapillary neoplasm (SPN) of the pancreas. (C, D) HE staining (100x and 200x) of the liver metastases at first discovery. (E-M) IHC examinations (200x) of the SPN which was positive for cytokeratin (CK), neuron-specific enolase (NSE), progesterone receptor (PR), synaptophysin (Syn) and Vimentin. The ki67 index was <=5%, whereas negative for chromogranin A (CgA), carcinoembryonic antigen (CEA), cytokeratins 8 and 18 (CK8/18). (N-P) IHC staining (400x) of the primary pancreatic tissue and liver lesions showed the high expression of beta-catenin.
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The pathology showed that the pancreatic tumor (5.5x6x4 cm) was composed of pleomorphic cells and polygonal cells that are either lamellar or arranged around a thin fibrovascular axis ( Figures 1A, B ). The Ki67 index was 3%, whereas negative staining for chromogranin A (CgA), carcinoembryonic antigen (CEA), cytokeratins 8 and 18 (CK8/18) ( Figures 1E-M ). During a follow-up of 5.1 years, CT scan and a liver biopsy confirmed the diagnosis of liver metastases ( Figures 1C, D ) and peritoneal metastases from SPN. IHC staining ( Figures 1N-P ). In March 2020, the patient subjected to the treatment of celecoxib (200mg qd), which is a specific Cox-2 inhibitor.
Representative clinical images during the treatment course. (A) Disease time line showed the various treatment received by the patient. (B) Scatter plot illustrates changes in liver metastases and peritoneal metastases. Computed tomography (CT) scan data at the first time to use celecoxib is chosen as time 0. (C) Computed tomography scan showed the multiple metastatic lesions in the liver and abdominal cavity under the celecoxib monotherapy. Tumor lesions were pointed with yellow arrows. (SPN, solid pseudopapillary neoplasm; CT, chemotherapy; RT, radiotherapy; NGC, next-generation sequencing).
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In December 2018, she was treated with gemcitabine and thalidomide as first-line chemotherapy for 5 cycles ( Figure 2A ). In May 2019, the tumors were evaluated as PD again, which led to second-line chemotherapy involving oxaliplatin and fluorouracil for 2 cycles and radiotherapy for 25 times ( Figure 2A ). Three months later, the CT scan showed progressive tumors in liver and abdominal cavity, so paclitaxel monotherapy was prescribed as third-line chemotherapy ( Figure 2A ). September 2019, the CT identified PD, the strategy switched to XELOX (capecitabine plus oxaliplatin) ( Figure 2A ). Six months later, the CT identified PD in liver and abdominal cavity. Therefore, the regimen was continued and the CT was performed to assess the tumor ( Figures 2B, C ).