case_images: PMC10924307_01
case_images: (A) Positron emission tomography-computed tomography (PET-CT) showed an abnormal FDG accumulation in the left pulmonary apex (SUVmax 12.58), no abnormal FDG accumulation in the gastrointestinal tract, and no suspicious findings of distant organ or lymph node metastasis. (B) Lung enhanced computed-tomography (CT) scan showed a massive soft tissue shadow, about 107 x 88 x 82 mm in the upper lobe of the left lung on October 14th. (C) Lung enhanced CT scan showed a soft tissue shadow, about 72 x 50 x 42 mm in the upper lobe of the left lung on January 4th after chemoradiotherapy, indicating a partial response with a reduction of 40%.
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case_images: We observed no evidence of lymph node enlargement ( Figure 1 ). Torrent Genexus system is designed to identify somatic variations in 50 cancer-related genes, including EGFR, ALK, KRAS, NRAS, BRAF, RET, MET, and NTRK. None of these genes exhibited any detectable mutations in this case. A systemic examination, including MRI of the head, CT scan of the chest and abdomen, positron emission tomography-computed tomography scan, upper and lower gastrointestinal endoscopy, and capsule endoscopy of the small intestine, revealed no neoplastic lesions, except in the lungs ( Figure 1A ). A chest CT performed in January 2021 indicated a partial response with a reduction of 40% ( Figures 1B, C ), and tumor markers improved to the normal range with CEA 1.9 ng/mL, CYFRA 1.1 ng/mL, and SLX 33.3 U/mL. TTF-1, PD-L1 (IHC 22C3), and p21, with a Tumor Proportion Score (TPS) of <1% ( Supplementary Figure S1 ). The fetus was delivered at extremely low birth weight, but is growing healthily.
case_images: Pathological and immunohistochemical examination results of lung biopsy. (A) hematoxylin-eosin staining (HE), magnification x40; (B) HE, magnification x100; (C) HE, magnification x200; (D) CDX-2 positivity, magnification x40; (E) CK7 positivity, magnification x40; (F) CK20 negativity, magnification x40.
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case_images: Figure 2 ). For genetic analysis, we conducted both the cancer gene panel using
case_images: Pathological examination results after lung cancer surgery. The nodular lesion beneath the inflamed lung is composed of almost completely necrotic tissue without evidence of viable atypical or carcinoma cells. The pathology results revealed no residual tumor (pathological complete response, Ef3). (A) HE, magnification x20; (B) HE, magnification x100; (C) HE, magnification x200.
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case_images: The pathology results revealed no residual tumor (pathological complete response, Ef3) ( Figure 3 ) or lymph node metastasis.
case_images: Timeline of clinical events from symptom onset to last follow-up appointment. (CT, computed-tomography; MRI, magnetic resonance imaging; PET-CT, positron emission tomography-computed tomography; GF, gastrofiberscopy; CF, colonofiberscopy).
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case_images: The treatment history of this patient is shown in  Figure 4 .