case_images: PMC6049053_01
case_images: (A) Chest computed tomography revealed a lobulated soft tissue (2.7x2.3 cm, arrow) with an irregular hollow shadow in the posterior segment of the upper left lung lobe. (B) Mediastinal and perihilar lymph node metastases were noted (arrow).
case_images: ott-11-4029Fig1.jpg
case_images: PMC6049053_01_ott-11-4029Fig1.jpg
case_images: f1-ott-11-4029
case_images: CYFRA21-1: 11.62 ng/mL; CA72-4: 17.89 U/mL; CA-125: 45.39 U/mL; and CA-153: 62.97 U/mL). Chest computed tomography revealed a lobulated soft tissue mass measuring 2.7x2.3 cm in the posterior segment of the upper left lung lobe, and an irregular hollow shadow existed in the foci (Figure 1A). Mediastinal and perihilar lymph node metastases were noted (Figure 1B).
case_images: (A) Three-dimensional reconstruction of computed tomography image revealed that the right upper humeral bone metastasis was combined with a pathological bone fracture (arrow). (B) Gastroscopy revealed an ulcer (arrow) of approximately 2x2 cm located in posterior wall of gastric corpus. (C) A rough uplift (arrow) of 1.5x2.0 cm was observed in the junction of duodenal bulb and descending part. (D) Endoscopic ultrasound-guided fine needle aspirate was performed on mediastinal lymph nodes (arrow).
case_images: ott-11-4029Fig2.jpg
case_images: PMC6049053_01_ott-11-4029Fig2.jpg
case_images: f2-ott-11-4029
case_images: Furthermore, the right upper humeral bone metastasis combined with a pathological bone fracture was observed (Figure 2A), which was confirmed by 99mTc bone scan. Gastroscopy revealed an ulcer of approximately 2x2 cm located in posterior wall of gastric corpus, and it was covered with white mucus and surrounded by congestion and edema (Figure 2B). In addition, a rough uplift of 1.5x2.0 cm was observed at the junction of the duodenal bulb and the descending part, leaving the bulbar lumen deformed and narrow (Figure 2C). Next, an endoscopic ultrasound-guided fine needle aspirate was performed on the mediastinal lymph nodes (Figure 2D).
case_images: (A) Mutational analysis on gastric, duodenal, bone, mediastinal lymph node metastases, and blood. Different colors represent unique mutation sites in each location. (B) The mutation abundance on all metastatic foci and blood. The p-value of <0.05 based on the 2-sided test is considered to be statistically significant.. Note: * nonsense mutation.
case_images: ott-11-4029Fig3a.jpg
case_images: PMC6049053_01_ott-11-4029Fig3a.jpg
case_images: f3-ott-11-4029
case_images: All the detected mutation genes and their abundance, the tumor mutation burden (TMB), and microsatellite stability types are shown in Figure 3A. Among all metastatic foci, the mutation abundance in the mediastinal lymph nodes (p,0.001), stomach (p=0.001), and bone (p=0.018) were significantly higher than that in blood, as shown in Figure 3B. (Results are expressed as mean +- SD.