PMC9797856_01
A serial pelvic MRI: T2-weighted sagittal and DWI-axial views and PET/CT images during treatment and follow-up (A) First recurrence at left supraclavicular lymph nodes (arrow), (B) Second recurrence at left lower neck lymph nodes (arrow), (C) Complete remission of second recurrence, thyroiditis was also noted, (D) Sustained free of disease since stopping immunotherapy.
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An enlarged left external iliac lymph node measuring 1.1 cm was also noted ( Figure 1 ). The pathological findings revealed endometrial tumor cells with a hobnail shape and abundant clear cytoplasm ( Figure 2A ) positive for HNF-1beta and focally positive for napsin-A in IHC staining, compatible with ECCC with local invasion to the whole layer of the myometrium as well as metastasis to the left ovary and ipsilateral side pelvic lymph nodes, FIGO stage IIIC1.
Representative images of hematoxylin and eosin stain (A), tumor cells with a hobnail shape and abundant clear cytoplasm (arrow); immunohistochemistry for PD-L1 (B) and four MMR proteins as MLH-1, PMS-2, MSH-2 and MSH-6 in the patient. (C-F), tumor cells with equivocal loss of MLH-1 [arrow, (C)], stromal cells for positive control [arrowhead, (C)]; tumor cells with complete loss of PMS-2 [arrow, (D)], stromal cells for positive control [arrowhead, (D)].
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The pathological findings revealed endometrial tumor cells with a hobnail shape and abundant clear cytoplasm ( Figure 2A ) positive for HNF-1beta and focally positive for napsin-A in IHC staining, compatible with ECCC with local invasion to the whole layer of the myometrium as well as metastasis to the left ovary and ipsilateral side pelvic lymph nodes, FIGO stage IIIC1. IHC staining for PD-L1 showed an expression of 35% according to the combined positive score (CPS) system but less than 1% according to the tumor proportion score (TPS) ( Figure 2B ). In addition, all of the cancer components exhibited an equivocal loss of MLH-1 and complete loss of PMS-2 expression ( Figures 2C-F ). Disease recurrence was observed again in a PET/CT scan in August 2018, showing progressive changes at the left lower neck and left supraclavicular nodes ( Figure 2 ).
A serial values of tumor marker CA-125 during treatment and follow-up. CA-125 level 111.6 and 19.1 U/ml at 1st and 2nd recurrence respectively.
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At the time of publication of this report, she has been disease free for 3 years since stopping pembrolizumab treatment ( Figure 3 ).