PMC10363725_01
Disease response to treatment with selpercatinib. The responses of left breast nodules and pleura are depicted in the row A and B, respectively.
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The patient underwent partial response of disease at the first radiological assessment ( Figure 1 ).
Timeline of treatments received by the patients from diagnosis to today. cfDNA, circulating free DNA; NGS, next-generation sequencing; PD, progressive disease; RT, radiotherapy; wt, wild type. Created with .
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Detailed timeline of treatments administered is depicted in  Figure 2 .
Gastrointestinal toxicity to selpercatinib; very light small bowel thickening was present in June 2022, when the patient started to refer abdominal pain (A, D). In October 2022 (B, E), important bowel wall thickening, mesenteric congestion, and stranding are shown. Complete resolution of the radiological pathological findings in February 2023 is depicted in (C, F).
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The subsequent computed tomography (CT) scan documented the presence of important bowel wall thickening, free ascitic fluid, mesenteric congestion, and stranding ( Figure 3 ).
Pathological examination of duodenum and jejunum biopsies from esophago-gastro-duodenoscopy. The red arrows in (B) and (C) show the presence of submucosal edema, whereas the black arrows in (A) and (D) indicate the increased number of intraepithelial lymphocytes T CD3+ and CD8+.
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At the final histology report, a type 1 (according to Marsh modified classification) lymphocytic duodenitis with sub-mucosal edema was diagnosed; in particular, an increased number of intraepithelial lymphocytes T CD3+ and CD8+ were found in the mucosa of duodenum and jejunum ( Figure 4 ).