case_images: PMC10619657_01
case_images: Summary of the diagnosis and treatment process.
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case_images: A 48-year-old Chinese man with a long-term history of smoking was diagnosed with stage IIB lung cancer in June 2020 ( Figure 1 ).
case_images: (A) Preoperative chest computed tomography revealing a 25 x 20-mm mass in the left upper lobe. (B) Pathological diagnosis of the resected specimen was lung adenocarcinoma. (C) Positron emission/CT examination showed abnormally increased fluorodeoxyglucose metabolism in the left hilar surgical region and mediastinal lymph nodes. The cytologic findings of CSF by lumbar puncture revealed adenocarcinoma cells. (D) An electronic fiber bronchoscopy revealed complete obstruction of the left upper lobe bronchus with a neoplasm protruding from the lumen at the opening and leading to left inferior basal segment external pressure stenosis. (E) The cytologic findings of CSF by lumbar puncture revealed adenocarcinoma cells.
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case_images: Preoperative chest computed tomography (CT) revealed the presence of a 25 mm x 20 mm mass in the upper lobe of the left lung, deemed resectable upon surgical evaluation ( Figure 2A ). P63. Pleural invasion and vascular cancer embolism were observed (pT2aN1M0 stage IIB; AJCC 8th edition) ( Figure 2B ). Figure 2E ). Electronic fiber bronchoscopy revealed complete obstruction of the left upper lobe bronchus, with a neoplasm protruding from the lumen at the opening ( Figure 2D ). Positron emission tomography/CT (PET/CT) indicated abnormally increased fluorodeoxyglucose metabolism in the left hilar surgical region, left thoracic entrance, mediastinal aortic arch, right lower paratracheal lymph nodes, carina lymph nodes, and right hilar lymph nodes ( Figure 2C ).
case_images: CT and MRI scans at different clinical time points, as indicated. (A) Chest CT scans before furmonertinib treatment. (B) Progression of thoracic lesions was observed after 2 months of furmonertinib. (C) The change in lung lesions after 3 months of furmonertinib and lung radiotherapy. (D) CT scans after 5 months of furmonertinib revealed a left-lung abscess. (E) T1-weighted imaging of brain MRI before and after 3 months of furmonertinib. The coronal plane revealed slightly swollen meninges. (F) T2-weighted imaging of brain MRI indicated mild hydrocephalus. (G) T1-weighted imaging enhancement scans revealed no leptomeningeal enhancement and no parenchyma metastases.
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case_images: Brain enhancement magnetic resonance imaging (MRI) examination revealed mild hydrocephalus and slightly swollen meninges without parenchyma metastases ( Figure 3 ). A chest examination revealed a new 3.3 cm mass in the left upper lobe hilar region, with right hilar and mediastinal lymphadenopathies ( Figure 3 ). By February 2022, after 3 months of furmonertinib and radiotherapy, both intracranial and pulmonary lesions were evaluated as stable disease (SD) ( Figure 3 ).