case_images: PMC10854399_01
case_images: Pathological and image findings of the patient on the first visit. (A) A chest CT scan on December 17, 2021 (A) revealed a soft tissue mass with a disrupted bronchus in the left lower hilar area. The mass had well-defined borders and measured approximately 2.9x1.3 cm with a CT value of approximately 46 Hounsfield units (HU). The arterial phase enhancement showed CT values of 105 HU and 122 HU, respectively. Atelectasis was observed in the left lower lobe. Multiple nodular opacities were found in both lungs, with miliary opacities and a larger opacity measuring approximately 0.7 cm in diameter in the right upper lung, showing spiculation and adjacent pleural traction. (B) A PET/CT scan on December 23, 2021 (B) showed increased FDG metabolism in a mass in the left lower hilar area with a maximum standardized uptake value (SUVmax) of 11.2, measuring 3.1x1 cm. This was suggestive of central-type lung cancer in the left lung with associated atelectasis in the left lower lobe. A small nodule measuring 0.8 cm in the right upper lobe showed increased FDG metabolism (SUVmax of 7.5). (C) depicts the pathological slide of the patient's tumor tissue stained with hematoxylin and eosin. (x400).
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case_images: A chest CT scan on December 17, 2021 (Figure 1A), revealed a soft tissue mass with a disrupted bronchus in the left lower hilar area. CD56 (NK-1)(-), CgA(-), CK7(-), Napsin-A(-), P40(+), Syn(-), TTF-1(-), Ki-67(+25-50%), and CK5/6(+). Combining the cytological findings with the immunohistochemistry results supported the diagnosis of poorly differentiated non-small cell carcinoma, with a tendency towards squamous cell carcinoma (Figure 1C).
case_images: Illustrates the treatment process of the patient, including therapeutic medications and relevant examination results.
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case_images: The patient had no abnormal blood routine during the double-drug treatment, so anlotinib maintenance therapy was selected. (Figure 2) April 2022, followed by maintenance treatment with anlotinib.
case_images: The image shows the lesion presentation on the same level of the patient's follow-up CT scan. The upper half of each image shows the most prominent area of lung atelectasis (indicated by the red arrow), while the lower half of each image depicts the largest site of the lesion (marked by the red arrow). (A) The upper part was atelectatic, and the lower part was a tumorous. (B) Comparison of patients treated with pembrolizumab combined with anlotinib after one cycle. The scan revealed bilateral subpleural linear opacities, irregularity of the left lower lobar bronchus, multiple nodular opacities, and miliary opacities, with the largest one measuring approximately 0.7 cm in the right upper lobe, presenting spiculation and adjacent pleural traction. (C) The patients were re-examined eight months after the diagnosis of lung cancer. (D) The patients were re-examined twelve months after the diagnosis of lung cancer.
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case_images: During this period, the patient underwent multiple follow-up examinations at the hospital, and the results are shown in Figure 3.