PMC6334783_01
The pathology and immunohistochemistry of the patient.. Notes: (A) H&E staining with surgical specimens. (B) Immunohistochemistry: dot-like positivity for CK20. (C) Immunohistochemistry: negativity for CK7. (A) 200x; (B, C) 400x.
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The results of pathological examination after surgery in local hospital showed a right thigh subcutaneous small cell malignant tumor of about 2.5x2.0x1.2 cm (Figure 1).
Changes in lesions during treatment of the patient.. Notes: (A) After surgery, before treatment; (B) after the first treatment; (C) after the second treatment; (D) after the third treatment; (E) after the fourth treatment; (F) after the fifth treatment; (G) after the sixth treatment; (H) after the seventh treatment; (I) after the eighth treatment. From the pictures, masses reduced significantly during two cycles (A-C). From the third cycle (D), tumors had a recurrent trend. After three cycles (D-F), tumors had started disappearing. From the sixth to eighth cycles (G-I), the masses were increasing gradually.
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In mid-July 2017, multiple red masses appeared in the surgical incision area, of which the largest was hard and about 1.5 cm in diameter (Figure 2A). After two cycles, the diameter of the major mass in the right thigh had reduced to 1 cm, and the remaining masses gradually subsided (Figure 2A-C). According to the RECIST standard, efficacy reached partial response. Before the third treatment, the masses became protruding, with a recurrent trend (Figure 2D). After the next three cycles of treatment, the masses were disappearing (Figure 2D-F), while the diameter of the lymph node in the right inguinal region had reduced to 1.3 cm (Figure 3C). However, from the beginning of the sixth cycle on February 14, 2018, there was a new lesion of 1.2 cm diameter at the right thigh (Figure 2G), which indicated progressive disease. Three treatment cycles later, the diameter of the mass had gradually increased to 3 cm (Figure 2G-I).
Changes on CT scans during treatment.. Note: (A) Metastatic lymph node (2.2 cm) on July 31, 2017; (B) metastatic lymph node (2.2 cm) on October 23, 2017; (C) metastatic lymph node (1.3 cm) on December 26, 2017; (D) metastatic lymph node (1.3 cm) on March 5, 2018.. Abbreviation: CT, computed tomography.
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A metastatic lymph node was found in the right inguinal region on computed tomography (CT), ~2.2 cm in diameter without distant metastasis (Figure 3A). On CT, there was no change from before (Figure 3B). After the next three cycles of treatment, the masses were disappearing (Figure 2D-F), while the diameter of the lymph node in the right inguinal region had reduced to 1.3 cm (Figure 3C). The latest CT on March 5, 2018 showed no significant changes compared with previously (Figure 3D).