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Case Reports
. 2023 Jan 27:14:1086760.
doi: 10.3389/fimmu.2023.1086760. eCollection 2023.

Case report: Advanced primary squamous cell carcinoma in the periampullary area with upregulation of programmed cell death-ligand 1 expression and response to sintilimab immunotherapy

Baoshan Wang  1 , Dazhou Li  1 , Dehua Zeng  2 , Wen Wang  1   3 , Chuanshen Jiang  1
Affiliations
Case Reports

Case report: Advanced primary squamous cell carcinoma in the periampullary area with upregulation of programmed cell death-ligand 1 expression and response to sintilimab immunotherapy

Baoshan Wang et al. Front Immunol. .

Abstract

Primary squamous cell carcinoma (SCC) of the periampullary area is exceedingly rare. We report a case of a 45-year-old woman who presented with progressive upper abdominal pain and melena. Laboratory testing revealed an elevated level of carcinoembryonic antigen. Esophagogastroduodenoscopy revealed a very large irregular ulcerated tumor in the periampullary area. Contrast-enhanced computed tomography (CT) of the chest, abdomen, and pelvis, 18 F-fluorodeoxyglucose positron emission tomography/CT, and thin-prep cytologic test excluded metastasis of the primary tumor to the periampullary area from other sites. Immunohistochemistry revealed positive p40 and cytokeratin (CK)5/6, indicating SCC. The expression of programmed cell death-ligand 1 (PD-L1) in tumor cells was upregulated, and the patient responded well to chemotherapy combined with immunotherapy. To the best of our knowledge, this is the first reported case of advanced primary SCC in the periampullary area with high expression of PD-L1.

Keywords: immunotherapy; periampullary; primary; programmed cell death-ligand 1; sintilimab; squamous cell carcinoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Esophagogastroduodenoscopy showing a very large irregular ulcerated tumor in the periampullary area. (B) Histopathology showing invasive moderately differentiated squamous cell carcinoma (hematoxylin and eosin staining, ×200 magnification). (C) Expression of P40 (×200 magnification) and (D) cytokeratin (CK)5/6 detected by immunohistochemistry (×200 magnification). (E) Expression of programmed cell death-ligand 1 (PD-L1; ×200 magnification) and (F) programmed cell death protein-1 (PD-1) detected by immunohistochemistry (×200 magnification).
Figure 2
Figure 2
(A) Abdominal contrast-enhanced computed tomography (CT) showed a mass approximately 5.8 × 4.7 cm in size in the periampullary area. (B) The largest lymph node in the retroperitoneal space was approximately 1.0 cm in size. (C) After treatment, abdominal enhanced CT showed shrinkage of the primary lesion. (D) The largest lymph node also shrank (red arrow).
Figure 3
Figure 3
Carcinoembryonic antigen levels during treatment.
See this image and copyright information in PMC

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