PMC8166484_01
CT scan of the neck at presentation (axial image).
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CT scan of the neck showed a large, right thyroid lobe mass measuring 7.5 x 4.1 cm, displacing the larynx and trachea to the left and encasing the internal carotid artery by at least 180  (Figures 1 and 2 ). CT scans of the chest, abdomen, and pelvis and an MRI scan of the brain showed no definitive evidence of distant metastases.
CT scan of the neck at presentation (coronal image).
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CT scan of the neck showed a large, right thyroid lobe mass measuring 7.5 x 4.1 cm, displacing the larynx and trachea to the left and encasing the internal carotid artery by at least 180  (Figures 1 and 2 ). CT scans of the chest, abdomen, and pelvis and an MRI scan of the brain showed no definitive evidence of distant metastases.
Cytology showing atypical discohesive cells consistent with ATC.
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A repeat FNA biopsy of the right thyroid mass revealed discohesive atypical pleomorphic tumor cells consistent with ATC (Figure 3).
Immunocytochemistry staining showing strong positivity for PD-L1.
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PAX8, and negative for calcitonin, CEA, SOX-10, and p63. PD-L1 22C3 pharmDx:performed on Dako Autostainer Link 48:was positive for high PD-L1 expression with tumor proportion score (TPS) >95% (Figure 4).
First CT scan of the neck after the initiation of pembrolizumab, 4 doses (axial image).
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Restaging scans after four cycles of treatment (one cycle equaling three weeks) revealed a partial response per RECIST v 1.1 (48% decrease in the size of the tumor) (Figures 5 and 6 ).
First CT scan of the neck after the initiation of pembrolizumab, 4 doses (coronal image).
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Restaging scans after four cycles of treatment (one cycle equaling three weeks) revealed a partial response per RECIST v 1.1 (48% decrease in the size of the tumor) (Figures 5 and 6 ).
CT scan of the neck after 25 doses of pembrolizumab (axial image).
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The patient has received 25 doses of pembrolizumab with continued reduction in size of tumor with most recent scans performed showing approximately 66% reduction in tumor from pretherapy (Figures 7 and 8 ).
CT scan of the neck after 25 doses of pembrolizumab (coronal image).
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The patient has received 25 doses of pembrolizumab with continued reduction in size of tumor with most recent scans performed showing approximately 66% reduction in tumor from pretherapy (Figures 7 and 8 ).