PMC3764965_01
Ki-67 (left) and synaptophysin (right) staining of pNET liver biopsy.
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F1
An analysis of tumoral tissue obtained by liver biopsy showed electron-dense granules containing synaptophysin and chromogranin A (CgA), high mitotic count (30/10 high-power fields), and high expression of Ki-67 (found in 30-40% of tumor cells) (fig. 1).
CT scans of the abdomen. a September 2009, after fifth-line paclitaxel. b November 2009, 2 months after the initiation of everolimus and octreotide LAR. c January 2010, partial response confirmed (>80% reduction in size per RECIST v1.0 criteria).
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F2
CgA concentration increased to 4,600 ng/ml, KPS decreased to 50%, and CT demonstrated massive hepatic and peritoneal tumor infiltration (fig. 2a). The patient achieved partial radiologic response (>50% decrease in tumor size) after 2 months of treatment (fig. 2b). Clinically important partial response (decrease in tumor size >80%) was confirmed by CT (as per RECIST v1.0; fig. 2c) and by reduced CgA levels after 8 months of therapy with everolimus (fig. 3).