On 14 December 2020, MR scanning showed that the number and size of the inguinal lymph nodes increased and were larger than the previous ones ( Figures 3F, G). During the treatment, MRI showed stabilization of the disease ( Figure 3E). Then, she underwent a chemotherapy and immunotherapy regimen consisting of albumin-bound paclitaxel and camrelizumab (a PD-1 inhibitor) for eight cycles. Due to the high price and limited specimen, only peripheral blood was used to detect PD-L1 expression. We recommended that she undergo whole-genome sequencing. However, MR scanning on 4 December 2019 revealed that the inguinal lymph nodes became larger ( Figure 3D). After the radiotherapy, the patient was reviewed regularly, and the tumor size was obviously reduced ( Figure 3C). Then, she received intensity-modulated radiation therapy (IMRT) with 60 Gy to the gross tumor volume (GTV) and 50 Gy to the clinical tumor volume (CTV). MRI revealed stabilization of the disease ( Figure 3B). Because the left lesions were surgically unresectable, the patient agreed to undergo a cytotoxic chemotherapy regimen consisting of docetaxel and nedaplatin every 3 weeks for seven cycles. Her magnetic resonance (MR) scanning image on 12 October 2018 showed that the number of lymph nodes increased in the bilateral inguinal region, and the left one was enlarged, suggestive of malignant disease ( Figure 3A). Pathological inspections confirmed the diagnosis of SGC, and immunohistochemistry results indicated that the mass was CK7+, P63+, CK5/6+, CK14+partial, GCDFP-15−, GATA-3−, p40−, and Ki-67 10% ( Figures 2A-F). Surgery was performed to remove the lesion on the left lower back on 25 September 2018 with a tumor-free margin. A positron emission tomography/computed tomography (PET/CT) scan was done on 21 September 2018, and it revealed a malignant tumor that was located on the left lower back with right pelvic wall and bilateral inguinal lymph node metastasis ( Figures 1A-C). Laboratory tests showed that the complete blood count and blood biochemical indicators were basically within the normal range. Physical examination revealed a palpable mass of about 4 × 2 cm in the left lower back and enlarged lymph nodes in the left groin. The patient had no previous medical history and no notable personal and family history. Then, she came to our hospital for further diagnosis and treatment. However, she still felt itchy and the nodule continued to grow. The patient was a 55-year-old woman who had a small itchy nodule in the left waist 20 years ago and received cryotherapy twice in 20.
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