case_images: PMC10618617_01
case_images: Changes in chest and upper abdomen contrast-enhanced CT, PET-CT, and brain MRI before and after treatment. (A) Baseline (left): Chest CT showed a space-occupying mass in the right upper lobe (10.6 x 8.5 cm), and the possibility of lung cancer was considered. PET-CT showed a large soft tissue mass with necrosis in the right upper lobe (12.2 x 11.3 x 12.6 cm) with increased annular metabolism (SUVmax: 27.3). Follow-up after 9 months of treatment (right): Chest CT showed that the lesion in the right upper lung lobe had become smaller (7.8 x 6.0 cm). PET-CT showed that the wall of the nodule and the solid component of the mass in the right upper lobe were smaller than before (6.8 x 9.0 x 7.9 cm), had a slightly lower SUVmax (25.7), involved the right chest wall, and partially extended into the right axilla. (B) Baseline (left): Abdominal CT and PET-CT showed no obvious abnormality of the adrenal gland. Nine months after treatment (right): Abdominal CT showed that the left adrenal nodule was enlarged and that a new nodule had formed in the right adrenal gland. PET-CT showed bilateral adrenal soft tissue masses; the larger one was located on the left side and measured about 4.1 x 3.6 cm with an SUVmax of 9.9 to 11.2. (C) Baseline (left): Brain MRI showed a left anterior central gyrus nodule (approximately 1.0 cm in diameter), and metastasis was considered. PET-CT showed a slightly dense nodule at the junction of the cortex and medulla in the left frontal lobe (1.1 x 1.4 x 1.0 cm) with an SUVmax of 26.2. Nine months post-treatment (right): Brain MRI showed that the left anterior central gyrus nodule was slightly smaller than the anterior one (about 0.9 cm in diameter), and the post-treatment inhibition of the activity of the metastatic focus was considered. PET-CT showed a slightly dense nodule (diameter of 0.8 cm) at the junction of the cortex and medulla of the left frontal lobe (SUVmax: sparse radioactive distribution). CT, computed tomography; PET-CT, positron emission tomography-computed tomography; MRI, magnetic resonance imaging; SUVmax, maximum standardized uptake value.
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case_images: PMC10618617_01_fonc-13-1241475-g001.jpg
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case_images: Positron emission tomography-computed tomography (PET-CT) revealed a large soft tissue mass in the upper lobe of the right lung, enlarged right pulmonary hilar lymph nodes, and a nodule at the left frontal lobe ( Figures 1A, C ). Brain magnetic resonance imaging (MRI) indicated left anterior central gyrus metastasis ( Figure 1C ). After eleven anlotinib cycles and nine pembrolizumab cycles, a January 2021 PET-CT scan indicated systemic progression ( Figures 1A, B ).
case_images: Histopathological staining of the puncture biopsy specimen from the upper lobe of the right lung showed the following results: PCK(-), EMA(focal+), Vim(+), Ki67(+, 60%), S-100(-), CD35(-), CD21(-), CD23(-), CD(scattered+), CD20(-), CK5/6(-), P63(-), CD56(scattered+), Syn(-), P40(-), CK7(-), Napsin A(-), TTF-1(-), ALK(-), AR(focal +), CD30(-), CK8/18(-), Mum-1(-), MyoD1(-), SATB2(+), PD-L1(+, TPS = 80%), CD8(+), CD4(+), CD25(+), Foxp3(-). Some of these results are shown in the figure: (A) EMA(focal+). (B) Vim(+). (C) Ki67(+, 60%). (D) SATB2(+). (E) PD-L1(+, TPS = 80%). (F) CD8(+). (G) CD4(+). (H) CD25(+). (I) Foxp3(-). TPS, tumor proportion score.
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case_images: Immunohistochemistry results were as follows: EMA (focal+), Ki67 (+, 60%), S-100(-), CK5/6 (-), CD56 (scattered+), Syn (-), P40 (-), napsin A (-), TTF-1 (-), and PD-L1 (+, tumor proportion score = 80%) ( Figure 2 ).
case_images: Time course of treatment and changes in the lung CT scans during treatments. Coronal and axial CT scans showed that the central necrotic area of the right upper lobe mass gradually became larger and more cavernous, and the solid cavity wall gradually became thinner. After 9 months of treatment, the right upper lobe mass began to enlarge and invade the chest wall and axilla. CT, computed tomography.
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case_images: f3
case_images: Regular bi-monthly CT scans of the chest and abdomen showed cavitation necrosis of the tumor expansion and cavity wall thinning ( Figure 3 ).