PMC9479725_01
Pathologic diagnosis: nonkeratinizing undifferentiated nasopharyngeal carcinoma. A - Tumor cells were arranged in irregular island-like, non-adhesive sheets or beams. Cancer nests were mixed with different numbers of lymphocytes and plasma cells. B - The tumor cells were large, syncytial-like, with ill-defined cell boundaries, round or oval vesicular nuclei, and a large central nucleolus. C, D - Immunohistochemical staining for PD-L1 expression (approximately 80% positive)
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Pathological biopsy combined with immunohistochemical results showed that it was consistent with (nasopharyngeal) nonkeratinizing undifferentiated NPC (Figure 1). Moreover, the expression of PD-L1 was high (approximately 80% positive, Figure 1).
Magnetic resonance imaging (MRI) showed the primary focus of NPC, lymph node metastasis in the neck, and liver and lymph node metastases in the head of the pancreas. A-D - Images of each lesion before treatment. E-H - Images of each lesion after five courses of chemotherapy combined with immunotherapy. I-L - Images of each lesion after chemoradiotherapy combined with immunotherapy
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Efficacy evaluation (Figure 2): partial response (PR) in the nasopharyngeal, PR in the cervical lymph node, complete response (CR) in the liver and lymph node in the head of the pancreas. Efficacy evaluation after radiotherapy (Figures 2-4): CR in the nasopharyngeal, CR in the cervical lymph node, and CR in the liver and lymph node in the head of the pancreas.
PET-CT showed the primary focus of NPC, lymph node metastasis in the neck, and liver and lymph node metastases in the head of the pancreas. A - Primary lesion before treatment. B - Before treatment, the largest cervical lymph node was 1.9 cm in short diameter. C - Before treatment, the largest liver metastasis was 1.4 cm in short diameter. D - Before treatment, the lymph node metastases in the head of the pancreas were 2.4 cm in short diameter. E-H - After treatment, the primary lesion, lymph node metastasis in the neck, and liver and lymph node metastases in the head of the pancreas completely disappeared
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Efficacy evaluation after radiotherapy (Figures 2-4): CR in the nasopharyngeal, CR in the cervical lymph node, and CR in the liver and lymph node in the head of the pancreas.
Nasopharyngeal endoscopy showed the primary focus of NPC. A - Watery discharge is seen in the right common nasal passage. B - On the right side of the pharyngeal recess, there is a raised mass with a non-smooth surface. C - Nasopharyngeal changes after radiotherapy and chemotherapy; nasal mucosa showing slight hyperemia. D - There was an abundant purulent secretion in the nasopharynx, and no obvious new organism was found
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Efficacy evaluation after radiotherapy (Figures 2-4): CR in the nasopharyngeal, CR in the cervical lymph node, and CR in the liver and lymph node in the head of the pancreas.
Treatment history
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The patient still maintained CR without adverse reactions. The complete treatment history is shown in Figure 5.