case_images: PMC9202532_01
case_images: Chest CT scan revealed multiple solid small nodules were scattered in both lungs, multiple nodules in bilateral pleura, multiple enlarged lymph nodes in mediastinum and bilateral hilum. A patchy soft tissue density shadow with a cross-sectional area of about 1.6 cm x 0.9 cm was seen near the heart margin of the lingual segment of the left lung, which was significantly enhanced by enhanced scan.
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case_images: Multiple lymph nodes enlargement occurred in the mediastinum (areas 3R, 4R/L, 5, 7) and hilar of both lungs with abnormal metabolism (Figure 1). Serum levels of FT3, FT4, and TSH during this period are shown in Figure 4 and Table A1.
case_images: Morphologic and IHC features. (a) Pathological examination of puncture biopsy of the left lung by hematoxylin and eosin (H&E) (100x magnification), scale bar 250 mum, (b-f) IHC positive staining for KI67 (~90% of the cells stained), PCK (punctate beside the nucleus), CK8-18, TIF-1 and PGP 9.5, (100x magnification), scale bar 250 mum.
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case_images: Histopathology showed a non-small-cell carcinoma with NE morphology (shown in Figure 2a), which was suspected to be LCENC, but the NE marker was negative. Immunohistochemical (IHC) results are summarized in Table 1, and all the positive staining is presented in Figure 2b-f.
case_images: Treatment process and therapeutic effect. (a) Schematic diagram of the patient's clinical treatment process. (b) Chest CT (computed tomography) scanning. PD, progressive disease.
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case_images: During the whole treatment, CT still showed SD, which is shown in Figure 3a and b. In addition, no new lesions were found in neck, chest, and abdomen enhanced CT, brain enhanced MRI, and systemic bone emission computed tomography ECT as shown in Figure 3b.
case_images: Time course of thyroid function of the patient during treatment with pembrolizumab.
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case_images: Serum levels of FT3, FT4, and TSH during this period are shown in Figure 4 and Table A1.
case_images: The patient's CA125 dropped to normal after treatment. Then slowly elevated from 46.4 to 79.9 ng/mL in the SD period. Up to Dec 2020, CA125 rapidly jumped to 287.8 ng/mL.
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case_images: Up to December 2020, CA125 rapidly increased to 287.8 ng/mL as shown in Figure 5.