PMC6190639_01
Changes of residual lesions showed by PET-CT.. Notes: (A) March 10, 2017, before chemotherapy and cytoreductive surgery; (B) September 19 2017, after cytoreductive surgery and nine courses of chemotherapy; (C) April 4, 2018, before secondary cytoreductive surgery.. Abbreviation: PET-CT, positron emission tomography-computed tomography.
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A whole-body positron emission tomography- computed tomography (PET-CT) revealed multiple metastases in the greater omentum, pelvic cavity, intestine surface, subcapsular of the liver, mediastinum, cardio phrenic angle, right internal mammary node and subclavian lymph node, and the largest metastases located in the left middle abdomen and next to the descending colon (sizes are 3.9x5.8x5.8 cm and 2.8x6.1x7.2 cm, respectively) (Figure 1A). After three cycles of PEB and bevacizumab chemotherapy, PET-CT (Figure 1B) showed resolution of her previous disease burden but a new metastasis emerged on the caudate lobe of the liver. A CT scan (Figure 6) and PET-CT (Figure 1C) both revealed multiple metastases around the whole body.
Some specimens at first cytoreductive surgery.. Notes: (A) Metastases located between spleen and descending colon; (B) omentum.
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The gross lesions were basically resected (Figure 2A and B), leaving only a small amount of miliary residues on the surface of the peritoneum.
Changes of residual lesions by cytoreductive surgery.. Notes: The yellow arrows represent metastases. Most metastases disappeared after cytoreductive surgery (left: before cytoreductive surgery; right: after cytoreductive surgery).
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Changes of residual lesions by cytoreductive surgery are shown in Figure 3.
Postoperative pathology proved the tumor was a MOGCT with immature teratoma (G2), small amount of YST and embryonal carcinoma.. Notes: (A) immature teratoma component (HE, 100x); (B) YST and embryonal carcinoma component (HE, 400x); (C) AFP immunostain diffusely positive in YST component (400x); (D) SALL-4 positive in YST and embryonal carcinoma component; (E) SOX2 positive in embryonal carcinoma; (F) AE1/AE3 positive in YST and embryonal carcinoma component.. Abbreviations: MOGCT, malignant ovarian germ cell tumor; YST, yolk sac tumor.
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Postoperative pathology (Figure 4) proved the tumor was a MOGCT with G2 IT, small amount of YST and embryonal carcinoma.
The result of comprehensive genomic profiling revealed an EGFR somatic mutation (p.L858R).
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AFP and beta-HCG gradually increased. At the patient's request and considering the suboptimal responsive of chemotherapy, a whole exme sequencing (WES) was performed and an EGFR somatic mutation (p.L858R) was identified (Figure 5).
CT scan revealed multiple metastases.. Notes: The yellow arrows represent metastases. Metastases were mainly located in the subcapsular area of the liver and in the right attachment area.
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A CT scan (Figure 6) and PET-CT (Figure 1C) both revealed multiple metastases around the whole body.
Metastases between liver and diaphragm.
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Metastases between liver and diaphragm are shown in Figure 7.
Serum AFP and beta-HCG levels during treatment.. Abbreviation: A, actinomycin D; AFP, alpha fetoprotein; B, bleomycin; Be, bevacizumab; C, cyclophosphamide; CRS, cytoreductive surgery; D, docetaxel; E, etoposide; F, FUDR; Ge, gemcitabine; I, ifosfamide; M, methotrexate; P, cisplatin; RCRS, re-cytoreductive surgery; RFA, radiofrequency ablation; T, taxol; V, vincristine.
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Changes in tumor markers during the whole course of the disease was shown in Figure 8.