case_images: PMC8784849_01
case_images: Hematoxylin-eosin staining and immunohistochemistry staining from pulmonary biopsy shows lung squamous cell carcinoma (LUSC) (A) and of pleural fluid-exfoliated cells shows lung adenocarcinoma (LUAD) (B).
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case_images: Lung fine-needle aspiration biopsy confirmed the diagnosis of low-differentiated LUSC at stage IVA (cT4N2M1a) (Figures 1A, 2A). LUAD cells (EC-positive, TTF-1-positive, napsin A-positive, P40-negative, P63-negative, D2-40-negative) were found by cytological examination of pleural effusion (Figure 1B).
case_images: Summary of treatment schedule and associated therapeutic effects. (A) Computed tomography (CT) from June 26, 2019, shows a lesion in the left lung and enlarged left mediastinal and hilar lymph nodes (red arrows). CT from March 30, 2020, shows partial response after six cycles of paclitaxel plus cisplatin chemotherapy and subsequent radiotherapy (red arrows). CT from October 13, 2020 shows progressive spread of the tumor within the chest associated with left pleural effusion (green arrows). CT from February 19, 2021, shows increased pleural effusion after one cycle of second-line chemotherapy (green arrows). CT from May 28, 2021, to August 30, 2021, shows well-controlled pleural effusion after five courses of nivolumab plus chemotherapy and four rounds of intrathoracic chemotherapy with recombinant endostatin followed by two rounds of that with recombinant endostatin plus carboplatin (green arrows). (B) Pleural effusion levels before and after treatment with nivolumab plus chemotherapy by B-mode ultrasound. (C) Treatment course and results.
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case_images: F2
case_images: Lung fine-needle aspiration biopsy confirmed the diagnosis of low-differentiated LUSC at stage IVA (cT4N2M1a) (Figures 1A, 2A). Chest CT and B-mode ultrasound revealed an increase in the amount of pleural effusion (from 4.2 cm in November 2020 to 6.4 cm in February 2021; Figures 2A, B). March to 3.7 cm in May by B-mode ultrasound, Figure 2B) with well-controlled symptoms of breathlessness and chest tightness, and the lung lesion appeared stable. Moreover, an improved Eastern Cooperative Oncology Group performance status score (from 2 to 0) was observed in the patient after treatment with nivolumab plus chemotherapy. Therapeutic response was stable until the last follow-up on August 31, 2021, according to the well-controlled and unmeasurable lung lesion, decreased pleural effusion tested by chest CT, and well-controlled symptoms (Figure 2A).