PMC9971810_01
Timeline of the patient: (B-G, H1, I) were taken with Chest CT scanner and (A, H2) were taken with PET-CT scanner; yellow circle: right pulmonary nodule; red circle: right pulmonary nodule; blue arrow: pleural effusion.
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In addition, multiple enlarged lymph nodes with increased FDG metabolism were observed in the mediastinum and right hilar region (1.6*1.3 cm, SUVmax19.5) ( Figure 1A ). The first-line treatment resulted in 16 months of progression-free survival (PFS) ( Figures 1B, C ). The patient's second-line treatment was based on the first-line treatment plus bevacizumab (docetaxel 60mg d1d8 + oxaliplatin 100mg d1d8 + bevacizumab 300mg d1 ivgtt q3w), which also achieved SD and led to 9 months of PFS ( Figures 1D, E ). Following the third-line treatment, the patient demonstrated a PFS of 28 months ( Figures 1F, G ). TTF-1(-), EMA(+), calretinin(mesothelial+), WT-1(mesothelial+) ( Figures 2A-F ). PET-CT revealed a soft tissue mass in the right hilar lung (26.7*38.4mm, SUVmax 20.05), focal high-density nodules in the right anterior chest wall (14*8mm, SUVmax 3.67), multiple nodules in both lungs, multiple lymph nodes in the bilateral clavicular region, bilateral hila and mediastinum (12mm, SUVmax17.06), and multiple lesions in the right pleura with abnormally high FDG metabolism (SUVmax 13.52) which were considered to be caused by multiple tumor metastases ( Figures 1H1, H2 ). The patient was started on fifth-line letrozole endocrine therapy since October 2021. In February 2022, CT scans revealed decreasing right upper lung hilar soft tissue shadow, right pleural fluid and mediastinal right hilar lymph nodes ( Figure 1I ).
Pathological features of the cell blocks of the pleural fluid. (A) The H and E stain showed that the tumor is composed of small round cells (magnification 100x). The immunohistochemical stain showed (B) CK7 (+) and (C) GATA3 (+) supporting breast cancer metastasis (magnification 100x). The immunohistochemical stain showed (D) ER (+), (E) PR (+), (F) HER-2(1+) representing Luminal A subtype (magnification 100x).
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TTF-1(-), EMA(+), calretinin(mesothelial+), WT-1(mesothelial+) ( Figures 2A-F ). PET-CT revealed a soft tissue mass in the right hilar lung (26.7*38.4mm, SUVmax 20.05), focal high-density nodules in the right anterior chest wall (14*8mm, SUVmax 3.67), multiple nodules in both lungs, multiple lymph nodes in the bilateral clavicular region, bilateral hila and mediastinum (12mm, SUVmax17.06), and multiple lesions in the right pleura with abnormally high FDG metabolism (SUVmax 13.52) which were considered to be caused by multiple tumor metastases ( Figures 1H1, H2 ). The patient was started on fifth-line letrozole endocrine therapy since October 2021.
Serum tumor biomarker during treatment.
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CA153 and CA125 showed a decreasing trend ( Figure 3 ). Currently, the PFS reached 10 months, and the patient is still under follow-up.