case_images: PMC11813767_01
case_images: Enhanced CT images of the lung mass. (A, B) CT images at the time of tumor detection. (C) The CT images before any treatment. (D) Enhanced CT scans after two courses of treatment indicated a slightly enlarged tumor with an overall stable efficacy. (E) A subsequent CT scan after the fourth course of treatment showed stable disease. (F) The CT images after eight courses of treatment suggested a decrease in tumor size. (G, H) Enhanced CT revealed no tumor recurrence after surgery.
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case_images: Enlargement of the right hilar and mediastinal lymph nodes was noted, along with a local invasion in the right 4th posterior rib ( Figures 1A, B ). Figure 1C ). Following consultation with thoracic surgeons, it was determined that, due to the tumor's enormous size and local invasion into the chest wall and ribs, surgical intervention was not indicated at this time. A follow-up CT scan showed stable disease (the tumor slightly increased in size to 114X104X160mm) ( Figure 1D ). A subsequent CT scan continued to show stable disease (a reduction in the size of the tumor to 109X90X152mm) ( Figure 1E ). A follow-up CT scan showed stable disease (the size of the tumor was reduced to 100X76X128mm) and the majority of the mass appeared cystic without enhancement ( Figure 1F ). Due to inflammation in the left lower lobe, a post-treatment follow-up was recommended ( Figures 1G, H ).
case_images: Pathology and fluorescence in situ hybridization (FISH) results of the lung aspiration biopsy. (A) Microscopic examination revealed spindle-shaped oncocytes arranged in bundles, oval-shaped nuclei, and frequent nuclear division. (B) FISH: FISH result (-), C-MET gene (no amplification), and C-MET signal exhibited a punctate distribution.
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case_images: Microscopic examination revealed spindle-shaped oncocytes arranged in bundles, oval-shaped nuclei, and frequent nuclear division ( Figure 2A ). Fluorescence in situ hybridization (FISH): FISH result (-), C-MET gene (no amplification), and C-MET signal exhibited a punctate distribution ( Figure 2B ).
case_images: Tissue and pathology after resection of the lung cancer. (A) (1) In the right upper lung, consistent with changes after tumor chemoimmunotherapy, no residual viable tumor cells were found in the tumor bed. (2) There was diffuse congestion and hemorrhage in the peripheral lung tissue, with no tumor tissue observed at the bronchial margin. (3) No tumor metastasis was observed in the lymph nodes of groups 2, 4, 7, 10, and 11, and the subcarinal lymph node (0/3, 0/3, 0/1, 0/1, 0/2, 0/2). (B) In total, 40% of the tumor cells exhibited positive PD-L1 expression.
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case_images: There was diffuse congestion and hemorrhage in the peripheral lung tissue, with no tumor tissue observed at the bronchial margin. (3) No tumor metastasis was observed in the lymph nodes of groups 2, 4, 7, 10, and 11, and the subcarinal lymph node (0/3, 0/3, 0/1, 0/1, 0/2, 0/2) ( Figure 3A ). The immuno-histochemistry results of the surgical tissue indicate a PD-L1 (TPS of 40%) ( Figure 3B ).
case_images: Diagnosis and treatment timeline.
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case_images: The patient's overall diagnostic and treatment process is shown in  Figure 4 .