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Abstract
Introduction/Background We present the rare case of a 23 year old woman with small cell carcinoma of the right ovary of the hypercalcemic type (SCCOHT). Initial diagnosis was at 20 years of age in September 2019, she presented with severe abdominal pain and a 16cm tumor of the right ovary. Electrolytes, including calcium were normal. First, oophorectomy of the right ovary performed. Following histological diagnosis of SCCOHT and staging via positron emission tomography (PET)-scan was done, en-bloc resection of the uterus and left adnexa, peritonenectomy, ometectomy and bowel resection with anastomosis of colon descendens and rectum was performed via laparotomy. TNM stage was pT3c N1 (3/7) L0 V0.
She received 4 cycles of adjuvant chemotherapy with cisplatin, etoposide and ifosfamid. Unfortunately, computertomography scan and magnetic resonance imaging (MRI) after chemotherapy revealed a new liver metastasis.
High-dosage chemotherapy with cyclophosphamide, followed by carboplatin and etoposide was applied followed by autologous stem cell transplantation. Despite extensive treatment MRI in October 2020 showed new disseminated liver metastases. PDL-1 testing showed a CPS (combined positive score) of 2. In November 2020 immunotherapy with pembrolizumab q21d was started. MRI in December 2020 showed remission of hepatic metastases under therapy with pembrolizumab [see image 5]. Additionally, brachytherapy of 20Gy with Iridium-192 in afterloading technique of hepatic segments IVa/VIII and VIII was done. Alternating PET-scan and MRI every 3 months showed no tumor recurrence.
To date, in April 2023, therapy with pembrolizumab is being continued without any sign of recurrence.
MRI prior to therapy with pembrolizumab
Methodology Case report
Results Our patient, a 23 year old woman with SCCOHT with hepatic metastases, is currently 29 months under treatment with pembrolizumab.
Conclusion This is the longest survival under pembrolizumab reported in the literature so far.
Disclosures None