PMC9875607_01
The effects of the therapy on the disease. Tumor size and cervical nodes size change from (A) and (B) baseline; (C) and (D) after three cycles of famitinib and camrelizumab treatment; (E) and (F) then after surgery and external radiation therapy.
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The trachea was shifted to the right and invasion of the internal jugular vein and common carotid artery was observed (Figure 1A,B). Tumors (version 1.1) (Figure 1C,D). The invaded internal jugular and common carotid arteries were separated. CT was performed to assess the response to camrelizumab in January 2021 (Figure 1E,F).
Core needle biopsy on left lobe: (A) and (B) the touch imprint cytology show the neoplastic tumor cells with obvious pleomorphism and nucleoli in some cells. (A) is hematoxylin and eosin histology section at 400x and (B) is Liu's stain at 400x. (C) the epithelioid tumor cells show solid growth cells which are obviously heteromorphic (hematoxylin and eosin histology section at 100x). (D) the nuclei of tumor are large, nucleoli are apparent and mitosis is easy to see (hematoxylin and eosin histology section at 400x).
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CT revealed multiple enlarged cervical nodes at levels II, III, and IV on the left side, each measuring approximately 20 mm. Core needle biopsy (CNB) of the prevailing thyroid nodule confirmed the diagnosis of ATC (Figure 2).
Immunohistochemically stained slides of core needle biopsy revealed the tumor cells to be positive for AE1/AE3, TTF-1, PAX8, P53 (70%) at 200x.
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TTF-1, HBME-1 (Figure 3). The cells were negative for thyroglobulin, desmin, and p63.
(A) and (B) show a surgical gross specimen; (C) and (D) show some foci poorly differentiated tumor nests were observed, with degeneration. Necrosis, desmoplasia, calcification, chronic inflammatory infiltration, and foamy histiocytes aggregates were found in surrounding areas, cholesterol crystals occasionally appeared (hematoxylin and eosin histology section at 40x and 100x).
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Postoperative pathological examination identified a 35-mm (maximum diameter) lesion in the left thyroid lobe (Figure 4A,B) and some poorly differentiated tumor nests with degeneration. Cholesterol crystals were observed occasionally, which was consistent with the changes observed after treatment (Figure 4C,D).
A coronal and a sagittal view of the post-operative radiation planning CT scan. The blue and yellow lines represent the 60 Gy and 54 Gy isodose lines, respectively and the staining areas within these lines represent clinical targets specified at 60 and 54 Gy, respectively.
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By August 2020, the patient had recovered well and received intensity-modulated radiation therapy (IMRT) with a dose of 60 Gy (in 30 fractions) to the thyroid bed and cervical nodal regions and 54 Gy to the mediastinal nodes (Figure 5).