case_images: PMC9909242_01
case_images: Positron-emission tomography-computed tomography (PET-CT) scan images demonstrating extensive metastatic disease at diagnosis with high maximum standardized uptake value (SUV) in lungs, lymph nodes (supraclavicular, paratracheal, prevascular, aortopulmonary, subcarinal and hilar bilateral), liver, left suprarenal gland and bone (all spine, sacred bone, pelvis, sternum, scapulas, right clavicle, ribs, humerus, and femurs).. A1) maximum-intensity-projection images on sagittal plane; A2) PET/CT sagittal view; B1) maximum-intensity-projection images on coronal plane; B2) PET/CT coronal view.
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case_images: PMC9909242_01_cureus-0015-00000033577-i01.jpg
case_images: FIG1
case_images: A PET scan confirmed advanced disease with several metastases: lung, lymph nodes, liver, left suprarenal gland, and bone (Figure 1).
case_images: 2A) Positron-emission tomography-computed tomography (PET-CT) scan image demonstrating lung metastasis at diagnosis (02/10/2017); 2B) thoracic CT scan after beginning erlotinib, showing disease response (30/11/2017); (yellow arrows: example of pulmonary lesions).
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case_images: FIG2
case_images: After a month of treatment, the patient presented a disease response with the disappearance of most lesions, without any adverse effects (Figure 2).
case_images: Cerebral MRI showing miliary cerebral metastasis.. 3A-3C) multiple hyperintense lesions in T1-weighted with gadolinium and in different axial planes; yellow arrows: example of cerebral lesions
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case_images: FIG3
case_images: After three chemotherapy cycles, the patient presented with dizziness and unsteady gait, and cerebral imaging was performed, showing miliary cerebral metastases (Figure 3).
case_images: Cerebral magnetic resonance imaging showing cerebral disease progression:comparison between March 2020 (4A) and July 2021 (4B); yellow arrows: new cerebral lesions.
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case_images: FIG4
case_images: The patient completed seven cycles of gemcitabine but experienced significant clinical deterioration, notably in the lungs, thoracic lymph nodes, and central nervous system (Figure 4).