PMC7654529_01
Histopathology from case 1. (A) x40. (B) x200.
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A 40-year-old male presented at the hospital and was subsequently diagnosed with squamous cell carcinoma of the thymus (Masaoka stage IV) in November 2004 (Figure 1).
CT images from case 1. (A) Chest CT revealing postoperative changes of thymic carcinoma, scattered fibrous foci of the left lung, left pleural hypertrophy with a small amount of pleural effusion. Soft tissue shadows are observed around the posterior mediastinal thoracic aorta. (B) PET-CT revealing the left mediastinal pleura and bilateral costal pleura were irregularly thickened, and some of them were accompanied by increased metabolism. Left pleural effusion and atelectasis of the lower left lung. Right hilar enlarged lymph nodes with increased metabolism were considered for metastasis.
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In June 2016 (Figure 2A), ICI therapy was initiated consisting of 40 cycles of nivolumab. That treatment continued until May 2018 (Figure 2B) and resulted in SD with a progression-free survival (PFS) time of 38 months.
PMC7654529_02
Histopathology from case 2. (A) x40. (B) x200. (C) CD5. (D) CD117. (E) P40. (F) P63.
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A small needle biopsy of the anterior mediastinal mass revealed poorly differentiated squamous cell carcinoma of the thymus (Figure 3).
CT images from case 2. (A) Chest enhancement CT revealing the maximum cross-section of the anterior mediastinal mass is 2.1x1.1cm in size (red arrow). (B) Chest enhancement CT revealing an irregular, ill-defined mass of the anterior mediastinal, difficult to accurately measure (red arrow). (C) Chest enhancement CT revealing the pleural effusion appears on the left side (red arrow). (D) The left pleural effusion was absorbed and soft tissue mass near the left posterior mediastinum smaller than before (red arrow).
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Upon examination, the patient showed only slight progress after the 3rd cycle (Figure 4A), and was switched to treatment with pembrolizumab plus anlotinib, which subsequently resulted in progressive disease. Combination therapy with anlotinib plus pembrolizumab was continued for 16 cycles as a part of a sequential regimen, resulting in the maintenance of stable disease until December 2019 (Figure 4B), when an enlarged pleural tubercle and new bone metastases were observed (Figure 4C). To our surprise, the patient exhibited a partial response (Figure 4D).