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  • We herein report a patient

    2019-04-22

    We herein report a patient with dMMR and MSI-H metastatic gastric cancer who prostaglandin receptor responded favorably and durably to PD-1 blockade. This patient, along with the previous two demonstrated by Le et al, are up-to-date the only 3 MMR gastric cancer patients who responded well to PD-1 blockade. Response to PD-1 blockade was also observed in patients with pMMR and MSS gastric cancer; therefore, the clinical implications of MMR function in gastric cancer require further investigation.
    Conflict of interest
    Introduction The most common scrotal pathology is primary testicular tumor, with an incidence of 5.4 cases per 100,000 men based on the US database. Although solid testicular masses should first be considered as germ cell tumor until proven otherwise, other uncommon pathologies should not be neglected for purposes of differential diagnosis. These pathologies include ectopic tissue, metastasis, and other neoplastic growths. The spectrum of pathology of suchneoplasia includes serous, mucinous, endometrioid, and clear cell carcinoma. These ovarian-type epithelial tumors usually occur in young and middle-aged adults. The mean age of patients with borderline serous neoplasm is 56 years (range 14–77 years), and 31 years for invasive tumor (range 16–42 years), respectively. There has been considerably less data regarding the very rare ovarian-type surface epithelial tumor of the testis and para-testicular tissue. The most commonly reported are serous tumors, with the majority of the cases being the borderline-type. However, serous tumors of the testis and para-testicular tissue remain rare, with only about 50 cases reported in the medical literature to date.
    Case report A 63-year-old man presented with right scrotal swelling of 3 weeks duration. Physical examination showed a firm tender lump in the right scrotum. The left testis was normal and there was no palpable lymphadenopathy in the groin. The patient\'s chest film was clear, and his abdominal CAT scan was unremarkable except that the pelvic part showed a multi-lobular cyst with an intramural component in the right scrotum suggestive of testicular tumor. Serum LDH level was high with 320 U/dL (normal range < 213 U/dL) whilst serum level of AFP 5.8 ng/ml (normal range < 10 ng/ml), and beta-HCG <1.20 mIU/ml (normal range < 5.0 mIU/ml) were normal. Thereafter, he underwent right inguinal radical orchiectomy. The pathological examination confirmed the diagnosis of testicular low-grade serous carcinoma of the ovarian epithelial-type with a component of the borderline tumor. Upon gross examination, the surgical specimen consisted of a testis measuring 11.9 × 6.7 × 5.7 cm, and spermatic cord with surrounding soft tissue of 4.3 cm in length. A well-demarcated tumor with solid, cystic, and papillary components of a grayish-white and yellowish color, measuring 8.2 × 5.7 × 4.2 cm, was confined within the testis, essentially replacing the testicle (Fig. 1). There were neither hemorrhage nor necrosis within the tumor. The epididymis and spermatic cord were unremarkable. Microscopic examination of the lining epithelium of the cyst revealed papillary tufts, mild to moderate nuclear atypia, and 2 mitotic figures/10 HPF (Fig. 2A and B). Additionally, there was invasion identified in the rete testis. Immunohistochemistry examination indicated that the epithelial lining stained positive with markers PAX8 (Fig. 2C), WT1 (Fig. 2D), CK5/6 (focal), and ER, respectively; it tested negative for D2-40. Although the initial serum LDH level was high, serial levels came back to nearly normal value in a stepwise manner with 269 U/dL, 241 U/dL and 229 U/dL at 3 months, 6 months and 9 months post-surgery, respectively. Repeated imaging at 6 months and 9 months post-surgery indicated no signs of recurrence. At the time of this report, the patient has been disease-free for 12 months post-surgery.
    Discussion