case_images: PMC6549397_01
case_images: Chest computed tomography (CT) scans were performed and images were recorded prior to any therapies. (A) The arrow shows a 24.1 mmx32.4 mm size lesion in the bottom lobe of the right lung. (B) The arrow shows a 49.0 mmx32.6 mm size lesion in the bottom lobe of the left lung.
case_images: OTT-12-4281-g0001.jpg
case_images: PMC6549397_01_OTT-12-4281-g0001.jpg
case_images: F0001
case_images: Chest computed tomography (CT) revealed two solid lesions located at the bottom lobes of the right (Figure 1A) and left lungs (Figure 1B).
case_images: Histologic features from synchronous multiple tumors. Hematoxylin and Eosin (H and E) staining revealed lung adenocarcinoma at both sides. Tissues were obtained by core needle biopsy from the bottom lobe of the right lung and the subsequent resection specimen demonstrated an Acinar-Predominant AC (A, Magnificationx200 and B, Magnificationx400). Tissues were obtained by core needle biopsy from the bottom lobe of the left lung and the subsequent resection specimen demonstrated an Acinar-Predominant AC (C, magnificationx200 and D, magnificationx400).. Abbreviation: AC, adenocarcinoma.
case_images: OTT-12-4281-g0002.jpg
case_images: PMC6549397_01_OTT-12-4281-g0002.jpg
case_images: F0002
case_images: After histological examination, invasive adenocarcinoma was suggested after observation of acinar cells with abnormal shape and size of nucleus in the bottom lobe of the right lung (Figure 2A, Magnificationx200, and Figure 2B, Magnificationx400), and in the bottom lobe of the left lung (Figure 2C Magnificationx200 and Figure 2D Magnificationx400); subsequently the diagnosis was confirmed by immunohistochemistry analysis with biomarker profiles of cytokeratin7 (CK) (+), thyroid transcription factor-1, (TTF-1) (+), CK5/6 (-), P63 (-) from the left lung tumor tissue, and a profile of CK7 (+), TTF-1 (+), CK5/6 (-), and P63 (+) from the right lung tumor tissue.
case_images: Chest computed tomography (CT) scans were performed and images were recorded after. (A) The arrow shows a 9.0 mmx9.0 mm lesion in the bottom lobe of the right lung after four cycles of chemotherapy; (B) The arrow shows a 41.0 mmx38.0 mm lesion in the bottom lobe of the left lung after fourcycles of chemotherapy; (C) The arrow showsa 5.0 mmx5.0 mm lesion in the bottom lobe of the right lung after 2months of icotinib; (D) The arrow shows a 55.0 mmx46 mm lesion in the bottom lobe of the left lung after 2months of icotinib.
case_images: OTT-12-4281-g0003.jpg
case_images: PMC6549397_01_OTT-12-4281-g0003.jpg
case_images: F0003
case_images: The response of the patient with chemotherapy was valued in accordance with the Response Evaluation Criteria in Solid Tumor (RECIST). The chest CT images were obtained after four cycles of chemo treatment, illustrating a dramatic shrinkage of the tumor size from 24.1 mmx32.4 mm to 9 mmx9 mm in the bottom lobe of the right lung (Figure 3A). A slight shrinkage of the tumor lesion from 49.0 mmx32.6 mm to 41 mmx38 mm was detected in the bottom lobe of the left lung (Figure 3B). The images revealed that the size of the tumor lesion in the right lung was further decreased from 9 mmx9 mm to 5 mmx5 mm (Figure 3C); whereas, the lung-tumor burden in the left lung continuously progressed from 41 mmx38 mm to 55 mmx46 mm (Figure 3D).