PMC9120574_01
Postoperative pathology revealed obvious heterogeneity in tumor cells with hyperchromatic, irregular nuclei and a foamy cytoplasm (HE, 400x).
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The pathological diagnosis report indicated that the mass on the outer right thigh was consistent with alveolar soft part sarcoma (ASPS) ( Figure 1 ).
CT scan images during treatment. (A) In May 2019, eight months following anlotinib treatment, new multiple lung metastases were observed. (B) In November 2019, six months following anlotinib combined with toripalimab treatment, lesions in the lung disappeared. Liver and sacral vertebrae metastases shrank. (Size was reduced from 5.5 cm x 5.4 cm to 3.5 cm x 3.8 cm). (C) In March 2020, CT re-examination indicated stable disease.
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However, in February 2019, following eight months of treatment, disease progression (PD) was observed (new multiple lung metastases occurred,  Figure 2A ), and soreness of the shoulder and upper arm was reported to be aggravated. In November 2019, CT re-examination indicated that the efficacy evaluation was a partial response (PR) ( Figure 2B ). Anlotinib combined with toripalimab was continued as treatment, and re-examination in March 2020 suggested that the disease was stable ( Figure 2C ).
Schematic picture showing the time line of treatment procedure.
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In March 2022, a CT re-examination indicated the efficacy was SD ( Figure 4E ) and PFS is 23 months (until the time of manuscript submission) ( Figure 3 ).
PMC9120574_02
Schematic picture showing the time line of treatment procedure.
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In March 2022, a CT re-examination indicated the efficacy was SD ( Figure 4E ) and PFS is 23 months (until the time of manuscript submission) ( Figure 3 ).
CT scan images during treatment. (A) In June 2018, left lung nodules and suspected metastasis of left adrenal nodule. (B) In September 2018, enlarged mediastinal lymph nodule and increased left adrenal nodule. (C) In April 2020, a new small bowel mass was found, left adrenal nodule was stable and mediastinal lymph nodule shrank. (D) In July 2020, left adrenal and mediastinal lymph nodule was stable. No small intestinal tumor was found. (E) In March 2022, left adrenal nodule shrank and mediastinal lymph nodule was stable.
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A CT scan revealed left lung nodules and lymphadenectasis in the mediastinum and left hilar and suspected metastasis of left adrenal nodule ( Figure 4A ). The tumor recurred three months later ( Figure 4B ). However, following 19 months of the treatment, the patient presented with abdominal pain and a small bowel mass was found, indicating tumor progression ( Figure 4C ). In July 2020, a CT re-examination indicated that tumors had shrunk ( Figure 4D ), and the efficacy evaluation was SD. In March 2022, a CT re-examination indicated the efficacy was SD ( Figure 4E ) and PFS is 23 months (until the time of manuscript submission) ( Figure 3 ).
(A-C) Pathology of left lung mass. (A) Pulmonary tumors with cytologic atypia,different nuclear sizes. Most of the nuclei are vacuolated, some nucleoli can be seen, and mitotic figures are obvious (HE, 400x). (B) Diffuse cytoplasmic positivity in tumor cells (Vimentin 200x). C:tumor cells are nuclear-positive, showing a hyperproliferative state. (ki67 200x) (D-F) Pathology of small bowel mass. (D) Small bowel tumors with different nuclear sizes. Most of the nuclei are vacuolated, some nucleoli can be seen, and mitotic figures are obvious (HE, 400x). (E) Diffuse cytoplasmic positivity in tumor cells (Vimentin 200x). (F) Tumor cells are nuclear-positive, showing a hyperproliferative state. (ki67 200x).
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However, postoperative pathology confirmed the pathological diagnosis was UPS ( Figure 5 ). April 2020, the other lesions are stable, therefore a local intestinal tract surgical excision was performed and the pathology showed UPS ( Figure 5 ). Anlotinib combined with toripalimab treatment (240 mg, ivd, d1, q3w) was then administered.