PMC9911416_01
(A) Timeline of therapy in a patient with unresectable PLPS who received preoperative RT plus anlotinib and achieved pCR after the surgery. (B) The initial CT scan revealed a soft tissue mass in the left abdominal cavity with the superior mesenteric artery passing through, measuring 7.4 cm x 6.2 cm x 7.2 cm in diameter. Scale bar = 10 cm. (C) Micrographs of hematoxylin and eosin (HE) staining. Scale bar = 50 mum. The latter two images showed the lip blasts in a circle. Scale bar = 25 mum. (D) The FISH image showed negative results labeled by CDK4, MDM3, and DDIT3 probes, respectively. Scale bar = 10 mum. (E) 3D reconstruction imaging displayed the relationship between tumors and vessels. Yellow, tumor; red, artery; blue, vein.
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The case management is described below, and Figure 1A provides a detailed timeline. Computed tomography (CT) was performed in June 2020 and showed a soft tissue mass, sized 7.4 cm x 6.2 cm x7.2 cm, in the left abdominal cavity with the superior mesenteric artery passing through (Figure 1B). A biopsy was performed, and histopathology revealed undifferentiated pleomorphic epithelioid or spindled cells, admixed with some cells presenting lipid vacuoles (Figure 1C). Fli-1 (-), OCT4 (-), SMA (-), Ki67 (20%+), CD31 (-), DOG1 (-), S100 (-), Des (-), and MDM2 (100%++). Fluorescence in situ hybridization (FISH) revealed no amplification of MDM2 and CDK4 and no rearrangement of DDIT3 (Figure 1D). Furthermore, 3D reconstruction imaging confirmed that the first branch of the superior mesenteric artery was surrounded by the tumor (Figure 1E).
(A) The CT scan showed that the tumor shrank remarkably after the treatment of perioperative RT plus anlotinib, measuring 2.8 cm x 1.9 cm. (B) The surgical specimens of the tumor, partial small intestines, mesentery, and superior mesenteric artery. (C) Micrographs of HE staining showed collagen tissue with no viable tumor cells. The images displayed blood vessels, histiocytes, and chronic inflammatory cells, which were pointed with arrowheads.
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October and December 2020, indicating notable tumor shrinkage to 2.8 cm x 1.9 cm (Figure 2A). On 29 January 2021, the patient underwent radical resection of the lesion and partial resection of the superior mesenteric artery and small intestines (Figure 2B). The pathology of surgical specimens displayed adipose tissue composed of large areas of hyperplastic collagen tissue, scattered small blood vessels, histocytes, and chronic inflammatory cells (Figure 2C).