PMC10365267_01
Treatment course of the patient. (A) History of treatment and examination details. (B) Representative CT images taken during the course of the disease: (a-c) correspond to CT1 of A; (d-f) correspond to CT2 of A; (g-i) correspond to CT3 of A; (j-l) correspond to CT4 of A; and (m-o) correspond to CT5 of A Yellow arrows indicate metastases. (C) Representative PET images during the course of the disease correspond to PET1 of A. (b) Corresponds to PET2 of A. Red arrows indicate sarcoidosis-like reactions. (c) corresponds to PET3 of A. CT, computed tomography; PET, positron emission tomography; LN, lymph node metastasis.
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Hence, the patient was treated with ipilimumab (1 mg/kg) and nivolumab (240 mg) as a third-line treatment ( Figure 1A ). Computed tomography scan after four courses of ipilimumab and nivolumab followed by three courses of nivolumab treatment (12 weeks after starting ICI therapy) revealed hilar/mediastinal lymphadenopathies, whereas abdominal lymph node metastasis markedly regressed ( Figures 1B, C ). Figures 2A, B ). Fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan revealed FDG uptake in the hilar/mediastinal lymphadenopathy and cutaneous lesions of the extremities ( Figure 1C ). After discontinuation of immunotherapy, the sarcoidosis-like reaction regressed without cancer relapse ( Figures 1B, C ).
Histology of mediastinal lymphadenopathy and cutaneous lesions. Representative images of hematoxylin-eosin stain of mediastinal lymph node (A, B) and cutaneous lesions (C, D). Representative images of immunohistochemical staining for PDL1 in the mediastinal lymph nodes (E, F). (A, C, E) low magnification images; (B, D, F) high magnification images.
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Figures 2A, B ). Fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan revealed FDG uptake in the hilar/mediastinal lymphadenopathy and cutaneous lesions of the extremities ( Figure 1C ). Cutaneous biopsy also revealed epithelioid cell granulomas ( Figures 2C, D ).