FIGURE 2
Expression of immune targets in tumor-infiltrating immunocytes of gestational trophoblastic neoplasia. LAG-3: lymphocyte activation gene-3; TIM-3: T cell immunoglobulin-3; GAL-9: galectin-9; PD-1: programmed cell death 1.
Source publication
Objectives: To evaluate the expression of emerging immune targets in the tumor-infiltrating immunocytes (TIIs) of human gestational trophoblastic neoplasia (GTN) specimens, and to analyze the correlation between the expression patterns and prognosis of GTN patients. Methods: Between January 2008 and December 2017, patients who were diagnosed histol...
Context in source publication
Context 1
... + regulatory T cells (Tregs) were detected in 8 choriocarcinoma samples but were not detected in PSTT and ETT. The expression of PD-1 in the TIIs was positive in 98 (90.7%) patients, and moderate-to-strong density was detected in 56 patients (51.9%) (Figure 2). TIM-3 and GAL-9 were expressed in the TIIs of almost all GTN patients (92.6% and 100%, respectively). ...
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Atypical placental site nodule (APSN) is a rare benign gestational trophoblastic disease (GTD). It is a tumor-like transformation that has a certain probability of developing into a placental site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT). Because of its atypical clinical presentation, it is difficult to diagnose and susce...
Citations
... Thought the current case did not received immunotherapy, and there is no report of patients with GTN and intracardiac metastasis who experience PD-1 and PD-L1 inhibitor, immunotherapy in GTN has made great progress in recent years, with successful therapeutic outcomes in several clinical studies [26][27][28][29]. Previous researches have revealed that programmed cell death ligand (PD-L1) is highly expressed in GTN tumor tissue [30,31], and other immune targets TIM-3, LAG-3, and GAL-9 are also widely expressed in GTN [32]. The CAP-01 clinical trial confirmed the efficiency and safety of PD-1 inhibitor in patients with chemo-refractory and relapsed CTN, and showed a 55% of objective response rate [28]. ...
Introduction
Gestational trophoblastic neoplasia (GTN) with intracardiac metastasis is rare, and here we reported a patient with intracardiac metastasis of high-risk and refractory gestational choriocarcinoma and reviewed relevant literatures.
Case presentation
A 37-year-old woman presented with vaginal bleeding and high level of β-human chorionic gonadotropin (β-hCG) at 199,060 (mIU/mL). It was clinically diagnosed with gestational choriocarcinoma. The patient initially received eight cycles of chemotherapy but unsatisfactory response was observed, and the level of β-hCG still ranged between 5000 and 10,000. Then there was found intracardiac masses in the right atrium (2.6*1.7 cm), anterior chordae tendineae of the tricuspid valve (1.4*0.7 cm) and the right ventricle (4.1*2.9 cm) by ultrasonic cardiogram (UCG). PET/CT highly suspected the intracardiac metastasis of choriocarcinoma (SUVmax = 9.3) and no disease was found in the lung and pelvis. The patient undertook complete intracardiac masses resection. The pathology confirmed the intracardiac metastasis of disease. After a week of operation, the UCG found a 5.4*4.2 cm mass in the right atrium again. Considering the poor prognosis, the patient received palliative care and eventually died of disease progression.
Conclusion
Intracardiac metastasis of GTN is an aggressive sign of disease. Patients can benefit from chemotherapy and surgery. Future investigation of PD-1 immunotherapy combines with chemotherapy are expected to improve the prognosis in this group of patients.
