Durable response to pembrolizumab in microsatellite instability‐high advanced adrenocortical carcinoma

Figures

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  Fig. 1. Axial image of abdominal CT indicating an 11 × 10 × 8 cm mass on the left adrenal gland (a). Coronal image of T2‐weighted abdominal MRI showing a tumor thrombosis of the left adrenal vein to the inferior vena cava (b). Hematoxylin–eosin histology shows a high nuclear grade, mitotic rate > 5/50 high‐power fields, atypical mitoses, clear cells composing 25% or less of the tumor, diffuse architecture, necrosis, venous invasion, sinusoidal invasion, and capsular invasion, which led to a full score for the 9 Weiss criteria (scale bar = 50 μm) (c).

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  Fig. 2. Before EDP‐M (a–c), after four cycles of EDP‐M (d–f), and after 15 months of PEM‐M (g–i). Axial image of abdominal and chest CT indicating a 10 mm mass of the inferior vena cava (a), a 13 mm mass at segment six of the liver (b), and a 6 mm mass at segment six of the lung (c) before EDP‐M. Axial image of abdominal and chest CT indicating a 4 mm mass of the inferior vena cava (d), a 7 mm mass at segment six of the liver (e), and a 4 mm mass at segment six of the lung (f) after four cycles of EDP‐M, which were in a stable disease state. Axial image of abdominal and chest CT indicating a 7 mm mass of the inferior vena cava (g), disappearance of the mass of segment six of the liver (h), and disappearance of the mass of segment six of the lung (i) after 15 months of PEM‐M, indicating a partial response.