PMC8798950_01
Pathological confirmation of left lung primary adenocarcinoma with a series of immunohistochemistry staining. Sections shown include HE staining, positive PD-L1 staining, positive CK7 staining, positive NapsinA staining and positive TTF-1 staining.
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Needle biopsy was performed, and subsequent HE staining and immunohistochemistry confirmed poorly differentiated adenocarcinoma with PD-L1(+), CK(+), NapsinA(+) and TTF-1(+) (Figure 1). Since the primary tissue immunohistochemistry showed strong positive PD-L1 expression (90%) (Figure 1), he entered the second line immunotherapy with IBI308 (sintilimab) (Innovent Biologics Co., Ltd) in a clinical trial (NCT02937116).
The response of primary tumors, new left lung nodules, mediastinal lymph node, adrenal, and liver lesions before immunotherapy and after 3, 4, 7, 10 cycles of immunotherapy. Partial response was observed with primary tumors, mediastinal lymph node and adrenal metastases, while new lesions at left lung and right liver lobe were found after three cycles of treatment. The new lesions continued to shrink until disappeared from cycle 4 to cycle 10, which was diagnosed as pseudoprogression.
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The left lower lung lesions and mediastinal lymph nodes became significantly smaller after 3 cycles of treatment, and were evaluated as partial response (PR), but computed tomography (CT) showed new lesions in the left lung and suspected metastases in the liver (Figure 2), with a bean-sized mass (1.7 cm x 1.5 cm x 0.7cm) appeared at gingiva of the right lower jaw and symptom of gingival pain was documented in the patient. Assessment at by the end of the 7th cycle showed significant relief of left lung primary tumor, left lung new lesion, mediastinal lymph node, adrenal metastases, and the suspected liver lesion, and was regarded as PR (Figure 2). Chest and abdomen CT showed stabilized primary and hepatic and adrenal lesions after 9 cycles of treatment (Figure 2), while the patient developed dizziness and nausea after 10 cycles of treatment. The patient reached the endpoint of clinical trial with progression-free survival (PFS) of 12.9 months (Figure 2).
Pathological confirmation of adenocarcinoma of gingiva metastasis with a series of immunohistochemistry staining. Sections shown include HE staining, positive CK7 staining, positive NapsinA staining and positive TTF-1 staining.
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TTF-1 (+) (Figure 3). The whole-exome sequencing (WES) showed that the main mutations of the gingival metastasis were ErbB2 amplification (3.1 copies), MET amplification (5.1 copies), PTEN amplification (3.0 copies) and TP53del (c.675_685del, 14.96%) with a large number of non-driver gene point mutations and insertion/deletion mutations (Tables 1,2).