case_images: PMC8437381_01
case_images: The chest CT outcomes during the whole treatment. (A) (A1-A3) Chest CT reveals primary lung cancer and metastases (red arrow); (B) tumor was PR after 2 cycles chemotherapy and gefitinib; (C) tumor was SD after 2 cycles chemotherapy and gefitinib again; (D) tumor was PD for taking gefitinib only; (E) tumor was PR again after 4 cycles the same chemotherapy and osimertinib; (F) tumor was PD again for taking osimertinib only. (G) Tumor was PR again after 2 cycles anlotinib.
case_images: CMAR-13-7047-g0001.jpg
case_images: PMC8437381_01_CMAR-13-7047-g0001.jpg
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case_images: Chest computed tomography (CT) demonstrated a lesion located in the upper lobe of right lung, and multiple nodules scattered in the bilateral lungs, consistent with a diagnosis of primary lung cancer and metastases (Figure 1A1-A3). After 2 cycles, efficacy evaluation indicated a partial response (PR) (Figure 1B). After another 2 cycles of the same therapy evaluation indicated steady disease (SD) (Figure 1C). After 2 months, she developed an intermittent cough and hemoptysis, chest CT illustrated that the tumor and metastases had increased in size (Figure 1D). After 4 cycles, evaluation indicated a PR (Figure 1E). After osimertinib only for maintenance therapy for 2 months, she developed an intermittent cough again and evaluation indicated progressive disease (PD) (Figure 1F). After 2 cycles, evaluation indicated a PR (Figure 1G), and SD after 4 cycles.
case_images: (A) H-E staining shows that SCC (blue arrow) presents a solid sheet-like arrangement. The cell cytoplasm is red stained, the nucleus is large, nucleoli and mitosis, no intracellular keratinizing and keratinizing beads are seen, but AC (red arrow) is adenoid, cord-like or solid arrangement. The cell cytoplasm is reddish or translucent, the nucleus is large and irregular, and nucleoli and mitosis can be seen. (x200). SCC accounts for about 10% and AC accounts for about 90% of the tumor. IHC staining shows: (B) CK5/6 and (C) P40 are positive in SCC components. (x200) (D) TTF-1 and (E) Napsin-A are positive in AC components. (x200) (F) Ki-67 index is about 70% in SCC (blue arrow) and about 30% in AC (red arrow). (x200).
case_images: CMAR-13-7047-g0002.jpg
case_images: PMC8437381_01_CMAR-13-7047-g0002.jpg
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case_images: Chest computed tomography (CT) demonstrated a lesion located in the upper lobe of right lung, and multiple nodules scattered in the bilateral lungs, consistent with a diagnosis of primary lung cancer and metastases (Figure 1A1-A3). The Ki-67 index was about 70% in the squamous cell carcinoma (SCC) component, and about 30% in the adenocarcinoma (AC) component (Figure 2A-F).
case_images: ARMS-PCR gene sequencing illustrated EGFR 18 (A), EGFR 19 (B), EGFR 20 (C) are negative, EGFR 21 (L858R) (D) and PIK3CA (H1047R/E545K) (E) concurrent mutations in AC component.
case_images: CMAR-13-7047-g0003.jpg
case_images: PMC8437381_01_CMAR-13-7047-g0003.jpg
case_images: f0003
case_images: Chest computed tomography (CT) demonstrated a lesion located in the upper lobe of right lung, and multiple nodules scattered in the bilateral lungs, consistent with a diagnosis of primary lung cancer and metastases (Figure 1A1-A3). ARMS-PCR sequencing demonstrated concurrent EGFR exon 21 (L858R) and PIK3CA (H1047R/E545K) mutations in the AC component (Figure 3A-E) She was diagnosed with primary lung adenosquamous carcinoma and bilateral lung metastases, disease stage IVA.