case_images: PMC11176515_01
case_images: Axial computed tomography images of the lung (A) and mediastinal (B) window show a lobular soft tissue mass in the left lower lobe.
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case_images: PMC11176515_01_fimmu-15-1371379-g001.jpg
case_images: f1
case_images: Computed tomography (CT) revealed a thoracic mass in the left lower lobe ( Figure 1 ). Moreover, no enlarged lymph nodes were detected in the retroperitoneum ( Supplementary Figure S1 ).
case_images: Pathological findings of surgical specimens. (A) Low-power view showing diffuse sheets and nests of slightly discohesive cells (H&E). Scale bar = 500 mum. (B) Vascular cancer thrombus (H&E). Scale bar = 200 mum. (C) Big round tumor cells, abundant eosinophilic cytoplasm with eccentric nuclei, and a high mitotic rate (H&E). Scale bar = 50 mum. (D) panCK, (E) CK7, (F) TTF-1 and (G) NUT showing tumor cell nonreactivity. (H) SALL-4 showing tumor cell reactivity, and (I) SOX2 showing focal tumor cell reactivity. The tumor cells display nonreactivity for (J) CD34, and vessels show reactivity for CD34. Both (K) SMARCA4 and (L) SMARCA2 are completely lost. Scale bar = 50 mum. (M) The programmed death ligand-1 tumor proportion score (PD-L1 TPS) is 1%, and the combined positive score (PD-L1 CPS) is 5. Scale bar = 10 mum. H&E, hematoxylin-eosin.
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case_images: PMC11176515_01_fimmu-15-1371379-g002.jpg
case_images: f2
case_images: The midline was centered and no significant abnormalities were seen in the bones and soft tissues ( Supplementary Figure S2 ). Supplementary Figure S2 ). Six cycles of tislelizumab plus EP induction therapy were administered as first-line chemotherapy, with cisplatin (40 mg/m2 on days 1-3), etoposide (100 mg/m2, days 1-3), and the immune checkpoint inhibitor (ICI) tislelizumab (200 mg, day 1), and then switched to the maintenance phase (continued tislelizumab 200 mg, day 1) without any special side effects (only mild nausea).
case_images: Chest computed tomography images showing the disappearance of the left lung metastasis (A), the shrinkage of the left axillary lymph nodes (B), and the shrinkage of the left pleural dissemination (C) after completing six cycles of tislelizumab plus etoposide and cisplatin induction therapy. Chest computed tomography images demonstrating a durable response after completing ten doses and fourteen doses of tislelizumab maintenance phase (Partial axillary lymph nodes disappeared after ten doses of tislelizumab).
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case_images: f3
case_images: Chest CT images ( Figure 3 ) were obtained after completing six courses of tislelizumab plus EP, revealing the disappearance of the left lung metastasis, shrinkage of all lymph nodes, and left pleural dissemination (best overall response: partial response, according to the RECIST version 1.1). Thoracic spine bone is unevenly hypodense ( Supplementary Figure S3 ).
case_images: Time since treatment initiation.
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case_images: f4
case_images: The patient continued treatment for 9 months without disease progression ( Figure 4 ).