case_images: PMC11798808_01
case_images: Baseline CT and CT after efficacy evaluation. (A1, B1) CT scan showed irregular strip soft tissue mass in the left hilar and upper lobe of the left lung, with a maximum cross-section of 4.7x3.0cm, left adrenal and left retrorenal masses and abdominal lymph nodes were considered to have metastasis. (A2, B2) CT scan showed that the soft tissue mass of left hilar and upper left lobe was reduced, and the metastatic lesions of left adrenal gland and posterior left kidney were smaller than before. (A3, B3) CT scan showed that the lesions of the left hilar - upper lobe of the left lung, double adrenal gland and internal posterior metastatic lesions of the left kidney continued to shrink compared with Dec 11, 2023. (A4, B4) CT scan showed that the soft tissue lesions in the left upper lobe of the lung and the metastatic lesions of posterior left kidney were enlarged again.
case_images: fonc-15-1509026-g001.jpg
case_images: PMC11798808_01_fonc-15-1509026-g001.jpg
case_images: f1
case_images: Oct 16, 2023, the serum carcinoembryonic antigen (CEA) level was > 979.0ng/ml (reference range 0-5), and the carbohydrate antigen 19-9 (CA19-9) level was 280.0U/ml (reference range 0-25). Other blood routine, liver and kidney function, blood glucose and lipids, thyroid function, hepatitis B virus, electrocardiogram results were basically normal. On Oct 18, 2023, CT scan showed irregular strip soft tissue mass in the left hilar and upper lobe of the left lung, with a maximum cross-section of 4.7x3.0cm, left adrenal and left retrorenal masses and abdominal lymph nodes were considered to have metastasis ( Figures 1A1, B1 ). CEA levels dropped to 173.0ng/ml (reference range 0-5), CA19-9 levels dropped to 90.60U/ml (reference range 0-25). CT scan showed that the soft tissue mass of left hilar and upper left lobe was reduced, and the metastatic lesions of left adrenal gland and posterior left kidney were smaller than before, assessed the efficacy as partial remission (PR) ( Figures 1A2, B2 ). CEA 20.60ng/ml (reference range 0-5), CA19-9 74.50U/ml (reference range 0-25). Compared with the CT scan on Dec 11, 2023, the left hilum and left upper lobe lung lesions, adrenal gland and left kidney internal posterior metastatic lesions continued to shrink, and the efficacy was assessed as continuous PR ( Figures 1A3, B3 ). CEA increased to 86.60ng/ml (reference range 0-5), CA19-9 increased to 108.50U/ml (reference range 0-25). CT scan showed that the lesions of upper lobe of the left lung and left kidney internal posterior metastatic lesions were enlarged again, and the curative effect was progression of disease (PD) ( Figures 1A4, B4 ).
case_images: HE staining and immunohistochemistry.
case_images: fonc-15-1509026-g002.jpg
case_images: PMC11798808_01_fonc-15-1509026-g002.jpg
case_images: f2
case_images: Histologically, the poorly differentiated tumor cells were arranged in nested clusters, and the cells were obviously atypical ( Figure 2C1 ). TTF-1 (-), CK8/18 (+), CK20 (-), CDX-2 (+), NUT (-) ( Figures 2C2-C5 ). There were no significant abnormalities in cerebral MRI, painless gastroscopy and colonoscopy and pulmonary enteric adenocarcinoma was diagnosed. CEA levels dropped to 173.0ng/ml (reference range 0-5), CA19-9 levels dropped to 90.60U/ml (reference range 0-25). CT scan showed that the soft tissue mass of left hilar and upper left lobe was reduced, and the metastatic lesions of left adrenal gland and posterior left kidney were smaller than before, assessed the efficacy as partial remission (PR) ( Figures 1A2, B2 ).
case_images: Timeline figure of the clinical course.
case_images: fonc-15-1509026-g003.jpg
case_images: PMC11798808_01_fonc-15-1509026-g003.jpg
case_images: f3
case_images: TTF-1 (-), CK8/18 (+), CK20 (-), CDX-2 (+), NUT (-) ( Figures 2C2-C5 ). There were no significant abnormalities in cerebral MRI, painless gastroscopy and colonoscopy and pulmonary enteric adenocarcinoma was diagnosed. CEA 20.60ng/ml (reference range 0-5), CA19-9 74.50U/ml (reference range 0-25). Compared with the CT scan on Dec 11, 2023, the left hilum and left upper lobe lung lesions, adrenal gland and left kidney internal posterior metastatic lesions continued to shrink, and the efficacy was assessed as continuous PR ( Figures 1A3, B3 ). A detailed timeline figure of the clinical course is shown in  Figure 3 .