case_images: PMC6604465_01
case_images: (a) Pathological findings: lung cancer tissue after pulmonary resection (x400 at original magnification). (b) Chest CT taken at admission revealed consolidation and atelectasis in the right lower lobe and right pleural effusion. (c) A 5 mm cranial lesion was found by head MRI at admission (upper panel: T1-weighted MRI, lower panel: diffusion-weighted MRI). (d) Pathological findings: the brain lesion which was resected (x400 at original magnification). (e) Chest CT taken three weeks later showed that consolidation and atelectasis improved, revealing ground glass opacities and multiple cavitary lesions in the right lower lobe. (f) On day 27, the brain lesion increased to 14 mm and exacerbation of cerebral edema around the brain lesion was observed by head MRI (upper panel: T1-weighted MRI, lower panel: diffusion-weighted MRI).
case_images: CRIONM2019-9141870.001.jpg
case_images: PMC6604465_01_CRIONM2019-9141870.001.jpg
case_images: fig1
case_images: IIA (pT2aN0M0) NSCLC after undergoing right middle lobe resection (Figure 1(a)). Immunohistochemistry of lung cancer and fluorescent in situ hybridization revealed ALK fusion-positive NSCLC. CRP was 2.6 mg/dl, and procalcitonin was 19.1 ng/ml. Chest CT revealed consolidation and atelectasis in the right lower lobe and right pleural effusion (Figure 1(b)). A 5 mm cranial lesion was also found by head MRI (Figure 1(c)). CRP decreased to 3.4 mg/dl after reaching a peak of 10.4 mg/dl. Chest CT revealed that consolidation and atelectasis in the right lower lobe improved, while ground glass opacities and multiple cavitary lesions appeared (Figure 1(e)). On day 27, the brain lesion increased to 14 mm and exacerbation of cerebral edema surrounding the brain lesion was observed, raising the possibility of brain metastasis (Figure 1(f)). On day 51, the brain metastasis was resected (Figure 1(d)), followed by whole brain radiotherapy (30 Gy/10 fractions).