Pseudo- or real progression? An ovarian cancer patient under nivolumab: A case report

Figure 1 A schematic model of pseudoprogression in a lymph node. A: Healthy lymph node without infiltration; B: Tumor cells infiltrating the tissue, which leads to growth; C: Infiltration of tumor cells into a preexisting tumor cell conglomerate resulting in a further growth; D: Immune cells and healthy tissue cells.

Figure 2 Posttreatment PD-L1 expression pattern in our patients’ high grade serous ovarian carcinoma and in tumor infiltrating lymphocytes. A: Tumor cell with strong positive membranous staining of PD-L1; B: Tumor with artificial membranous and some cytoplasmatic staining of PD-L1 as well as some immune cells with PD-L1 expression; C: For comparison: an example of PD-L1 staining in immune cells.

Figure 3 Tumor biopsy before and after treatment with nivolumab. A: Pretreatment tumor biopsy in 2012, HE-stain. Note the intratumoral lymphocytes (TILS); B: Posttreatment tumor biopsy of the high-grade serous carcinoma of the left colic flexure in 2016, HE-stain. Note reduced intratumoral lymphocytes.

Figure 4 Biopsy of a lymph node after nivolumab treatment. Activation of a lymph node including increased Ki-67 positive interfollicular population.