PMC8668246_01
Hematoxylin-Eosin (HE) staining and immunohistochemistry of the OCCC. (A) HE staining determined it was an ovarian cancer; Magnification: 200X. (B) Positive of Napsin A determined it was an OCCC. Magnification: 200X. (C) The patient's tumor had positive expression of PD-L1 (tumor proportion score of 10%). Magnification: 100X.
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Postoperative pathologic results showed ovarian clear cell carcinomas with stage T1aN0M0 disease with no HPV infection (Figure 1A). In addition, IHC results were positive for NapsinA and PAX-8, partially positive for P16, and negative for ER, PR, P53, Vim and WT-1 (Figure 1B). NGS results obtained from Onco PanScanTM (Genetronhealth) showed PIK3CA R88Q hotspot mutation (frequency 38.9%) and high PD-L1 expression levels (tumor proportion score of 10%) (Figure 1C).
Magnetic resonance imaging results of pelvic cavity, pelvic floor peritoneum and abdominal wall one month after surgery (A-C), at recurrence (D-F), four months (G-I) and eight months (J-L) after everolimus plus Toripalimab. The yellow arrow represents the lesion.
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The larger cyst with a size of 48*24 mm was located on the right side of the pelvic cavity (Figure 2A). No abnormality was observed in the pelvic floor peritoneum (Figure 2B), whereas scar shadows were observed on the abdominal wall (Figure 2C). However, the size of the cystic shadow on the right side of the pelvic cavity was smaller than that before Taxol and carboplatin treatment (24*15 mm in size) (Figure 2D). In addition, a new nodular and irregular thickening was observed in the pelvic floor peritoneum with the larger one having a size of 34 mm in length (Figure 2E). Furthermore, a new irregular nodule was observed on the right abdominal wall, with a size of approximately 20*32 mm (Figure 2F). An MRI was performed on 29 October, 2019 (four months after treatment with this approach), and showed no significant change in the size of the cystic shadows on the right side of the pelvic cavity (Figure 2G). However, a significant decrease in nodular and irregular thickening in the pelvic floor peritoneum was observed (Figure 2H). Moreover, the irregular nodule on the right abdominal wall was reduced in size (from 20*32 mm to 18*16 mm) (Figure 2I). Eight months after combinatorial treatment (February 21, 2020), MRI results showed a reduction in the size of the cystic shadow on the right side of the pelvic cavity (18 mm in diameter) (Figure 2J). The nodule observed previously in the pelvic floor peritoneum disappeared, whereas irregular thickening and a new nodule were observed in the pelvic floor peritoneum (Figure 2K). However, the size of the irregular nodule on the right abdominal wall increased (from 18*16 mm to 24*17 mm) (Figure 2L).