Recurrent undifferentiated embryonal sarcoma of the liver in adult patient treated by pembrolizumab: A case report  

作　　者：Xiao-He Yu Jian Huang Nai-Jian Ge Ye-Fa Yang Jin-Yan Zhao 

机构地区：[1]Department of Radioactive Intervention,Eastern Hepatobiliary Surgery Hospital,The Second Military Medical University,Shanghai 200438,China [2]Zhongshan Hospital Qingpu Branch,Fudan University,Shanghai 200092,China [3]Department of Laboratory Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China

出　　处：《World Journal of Clinical Cases》2021年第10期2281-2288,共8页世界临床病例杂志

基　　金：National Natural Science Foundation of China,No.31971249.

摘　　要：BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a neoplasm that rarely develops in adults.The main treatments for UESL are upfront gross total surgical resection and adjuvant multiagent chemotherapy.Here,we report a case of recurrent UESL in an adult treated with pembrolizumab and discuss a method to identify proper candidates for antibody of programmed cell death protein 1(anti-PD-1)treatment.CASE SUMMARY A 69-year-old woman was admitted for abdominal pain that developed for 1 wk.Computed tomography showed a 16 cm mass in the right lobe of the liver.Right hemihepatectomy and lymphadenectomy were performed,and histological diagnosis was UESL.Six months later,the patient suffered from painless obstructive jaundice,and positron emission tomography-computed tomography revealed multiple metastases.Then,percutaneous transhepatic cholangial drainage was applied to reduce jaundice,and radiofrequency ablation was used to control the lesion near the hepatic hilum.However,the patient suffered from a serious fever caused by the tumor.The patient received treatment with pembrolizumab,and the prescribed dosage was 2 mg/kg every 3 wk.After the seventh dose,positron emission tomography-computed tomography revealed that the multiple metastases had nearly disappeared.Radiologic exam was used to evaluate the disease state,and no new lesions were found.Next-generation sequencing and immunohistology were applied to determine the reason why the patient had such a favorable response to pembrolizumab.Tumor mutation burden,microsatellite instability,and programmed death ligand 1 expression can be combined to predict the effect of PD-1 antibodies. When every one of thesebiomarkers are detected in a tumor patient, the patient may be a proper candidatefor PD-1 antibodies.CONCLUSION Anti-PD-1 treatment for tumors needs further research to identify indications andproper biomarkers.

关 键 词：Undifferentiated embryonal sarcoma of the liver Pembrolizumab Programmed cell death protein 1 Tumor mutation burden IMMUNOHISTOLOGY Case report 

分 类 号：R735.7[医药卫生—肿瘤]