case_images: PMC11792341_01
case_images: Computed tomography (CT) scan of primary lesion (A) and left hilar lymph node (B) before neoadjuvant nivolumab combination chemotherapy. Positron-emission tomography/CT of primary lesion (C) and left hilar lymph node (D) before neoadjuvant nivolumab combination chemotherapy. CT scan of primary lesion (E) and left hilar lymph node (F) after one cycle of neoadjuvant combination chemotherapy
case_images: 44215_2025_187_Fig1_HTML.jpg
case_images: PMC11792341_01_44215_2025_187_Fig1_HTML.jpg
case_images: Fig1
case_images: Computed tomography (CT) revealed a 58 mm mass in the left upper lobe (LUL, Fig. 1A). Additionally, other small nodules suggestive of intrapulmonary metastases were also identified in the LUL (cT3[PM1], Fig. 1A). The left hilar lymph node was mildly enlarged (Fig. 1B). Positron emission tomography/CT (PET/CT) revealed abnormal accumulation at the tumor in the LUL with a standard uptake value-max (SUV-max) of 17.01 (Fig. 1C). Moreover, PET/CT demonstrated abnormal accumulation in the lymph nodes at the left pulmonary hilum with SUV-max of 5.65, raising suspicion of lymph node metastasis (cN1, Fig. 1D). The tumor size decreased from 58 to 20 mm, leading us to classify the treatment response as a partial response (15%) (Fig. 1E). The left hilar lymph node was slightly reduced in size (Fig. 1F). Mild adhesions were observed between the LUL and the chest wall; however, no adhesions, fibrosis, or lymph node involvement were noted around the pulmonary artery, pulmonary vein, or bronchus at the pulmonary hilum that would interfere with surgery (Supplementary Fig. 1).
case_images: Pathological images of surgically resected specimens with a primary tumor of the left upper lobe. Images of necrotic tumor bed in 40 x (A) and 200 x (B) magnification. Images of residual tumor cells in 40 x (C) and 200 x (D) magnification
case_images: 44215_2025_187_Fig2_HTML.jpg
case_images: PMC11792341_01_44215_2025_187_Fig2_HTML.jpg
case_images: Fig2
case_images: The pathological diagnosis was papillary-predominant adenocarcinoma (component: papillary 80%; lepidic 20%) (Fig. 2A and B). The residual viable tumor cells accounted for 15%, and the effectiveness of neoadjuvant therapy was evaluated as Ef.2 (Fig. 2C and D).