Firugre
1 : Magnification of 40x, staining with : Synaptophysin-positive (A), CK
20-positive (B), CK AE1 / AE3-positive (C)
After initial excision patient was not reffered to an oncologist. After
two months she developed symptoms of an infection and pain in the anal
region and was admitted to a hospital . She was operated on and
extirpation of the reamining tumor was performed. Pathohistological
examination of sample was described as: ADENOCARCINOMA (GRADUS III).
Immunohistochemistry: CK PAN-positive, CK 20-positive, S-100-negative,
VIMENTIN-negative, LCA-negative, CK7-negative, CK 5/6-negative.
She was refferd to the oncologist, two months after the initial
diagnosis. At first appointment her ECOG PS was 0 . An ultrasound
examination (US) of the abdomen, small pelvis and inguinal regions was
performed and it confirmed metastatic disease ; left iliac lymph node
4.7 cm in size and a conglomerate of pathologicaly altered lymph nodes
in the ingunal region on the left 10 x 8 cm in size. A biopsy was
performed and the pathological report showed that the sample
morphologically and immunohistochemically corresponds to the previously
diagnosed tumor: MIXED ADENONEUROENDOCRINE CARCINOMA-MANEC,
Synaptophysin-positive, Chromogranin A-positive, CD56-positive, CK
20-positive, NSE-positive, CK7-negative, Ki67-about 90% of tumor cells
show nuclear positivity. Patient was presented to the MDT and the
desicion was made to start with PE regimen in the first line of
treatment . After two cycles , there was an evident clinical progression
and she started to have difficulty walking Lab reports showed elevated
levels of CYFRA 21-1 5.3 ng / ml , LDH 444 U / L and NSE 140,2 ng / ml.
Progression-free survival (PFS) for the first-line of chemotherapy was 1
month. In the second line patient was treated with
paclitaxel and ifosfamide (PI) combination chemotherapy.After three
cycles of therapy initial responce was stable disease . Patient
progressed after six cycles CT showed enlargement of the mass in the
left ingunal region , now 10x9x6.5 cm in size , mass in the pelvis now
10 cm in size (Figure 2) , onset of peritoneal carcinomatosis and
cutaneous and subcutaneous metastatic deposits . She had worsening of
her previous condition , limited movement in her left leg and developed
DVT . She started LMWH for treatment of DVT . Her ECOG PS was 3.PFS for
second-line of therapy was 4 months.