PMC5754285_01
Chest computed tomography scans in a patient with pulmonary pleomorphic carcinoma. (a) Before treatment with carboplatin/paclitaxel, no tumor is detected in the left adrenal gland. (b) After five courses of carboplatin/paclitaxel therapy, a new 15 mm tumor (arrow) is seen in the left adrenal gland. (c) Before treatment with nivolumab, after three cycles of docetaxel, the size of the adrenal tumor increased to 25 mm in diameter (arrowhead). (d) After six courses of nivolumab therapy, the adrenal tumor was eliminated.
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The patient received five courses of carboplatin and paclitaxel chemotherapy, but a new metastatic lesion in the left adrenal gland appeared five months after the commencement of treatment (Fig 1a,b) and did not respond to three subsequent courses of docetaxel (Fig 1c). The tumor rapidly regressed and a complete response was achieved on the third administration (Fig 1d).
Photomicrographs of the transbronchial biopsy specimen taken from a patient with pulmonary pleomorphic carcinoma. (a) Cancer cells with large-sized nuclei are seen (hematoxylin & eosin stain, original magnification 400x). (b) Immunohistochemical examination showed that > 90% of the tumor cells expressed PD-L1 at a high intensity (SP142 clone stain, original magnification 400x).
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Histopathologic review of the surgical specimen at the time of diagnosis showed proliferation of cancer cells with intratumoral infiltration of mononuclear cells (Fig 2a). PD-L1 (Fig 2b). Prominent
Immunohistochemical examination of tumor-infiltrating immune cells in a patient with pulmonary pleomorphic carcinoma. (a) CD3+ lymphocytes, (b) CD68+ macrophages, (c) CD8+ cells, (d) CD4+ cells, (e) PD-1+ cells, and (f) FOXP3+ regulatory T cells are seen within the tumor (original magnification 100x).
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CD3+ T lymphocytes and CD68+ macrophages were found in the tumor (Fig 3a,b). CD56+ natural killer cells were not detected (data not shown). Infiltration of CD8+ cells was more predominant than that of CD4+ cells (Fig 3c,d). T cells (Tregs) were scattered in the tumor (Fig 3e,f).