PMC9251297_01
Radiographic findings before the treatment. (A, B) Preoperative CT scan showing the masses in the uterus and bilateral ovaries. MRI T2WI (C) and DWI (D) showing the mass in the uterus.
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The abdominal CT scan showed an irregular and uneven mass (92 x 93 mm) spreading from the uterine fundus to the cervix with inhomogeneous enhancement ( Figure 1A ). Besides this, masses with enhancement were found in the bilateral ovaries (left 20 x 15mm, right 24 x 25 mm) ( Figure 1B ). MRI showed that the mass in the uterus had an equal signal in T1WI, mixed (high or equal) signal in T2WI, and obviously high signal in DWI ( Figures 1C, D ).
Pathological findings. (A) Coexistence of small cell neuroendocrine carcinoma (SCNEC) and endometrioid adenocarcinoma in the uterus (H&E, 5 x 10). (B) The SCNEC area shows small round cells in nests and clusters (H&E, 10 x 10). (C) Typical features of endometrioid adenocarcinoma (H&E, 10 x 10). Immunohistochemistry staining positive for (D) CD56 (10 x 10), (E) CgA (20 x 10), and (F) Syn (10 x 10). (G) PD-L1 expression of our case, (H) Positive control of PD-L1, (I) Negative control of PD-L1.
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The pathological results are presented in  Figure 2 .
Radiographic findings during the treatment. (A) CT scan of the posterior peritoneum before surgery. (B) Multiple enlarged and merged lymph nodes were found in the posterior peritoneum at 1 month after surgery. (C) The lesions were obviously shrunk and evaluated as partial response after 2 cycles of combined treatment. (D) The disease achieved complete response during the consolidation treatment of toripalimab.
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At 1 month after surgery (August 27), multiple enlarged and merged lymph nodes were found in the posterior peritoneum, surrounding aorta, and postcava and bilateral iliac vessels, which were not found in the CT scan before the operation ( Figures 3A, B ). After two cycles of treatment, the lesions were obviously shrunk and evaluated as partial response (PR) according to RECIST 1.1 standard ( Figure 3C ). During the consolidation treatment of immunotherapy, the lesions were continuously shrunk and achieved a complete response (CR) ( Figure 3D ).