case_images: PMC9733669_01
case_images: Disease status before treatment. The PET-CT scan (A) showed that before treatment, the size of the lung field from the right hilum to the right upper lobe of the lung large cystic solid mass was 8.6 x 5.9 x 9.9 cm. (B) The electronic bronchoscopy of the patient before treatment. (C) Pathological diagnosis of the patient before treatment.
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case_images: As the timeline of the clinical course in this patient ( Supplementary Figure 1 ), On August 23th, 2021, a positron emission tomography-computed tomography (PET-CT) revealed a large cystic solid lesion (8.6 x 5.9 x 9.9 cm) in the lung field from the right hilum to the right upper lobe, which was considered to be a right thoracic malignant tumor. Additionally, multiple enlarged lymph nodes were observed in both hilum, mediastinum and right supraclavicular fossa, with the largest being 1.5x1.4 cm, with mild to moderate increase in metabolism, which was considered as multiple lymph node inflammation ( Figure 1A ). August 26th, 2021, an electronic bronchoscopy revealed stenosis of the right upper lobe opening and obstruction of the lumen by necrotic material ( Figure 1B ). An electronic bronchoscopy biopsy of the superior lobe of right lung led to a pathological diagnosis of PSC ( Figure 1C ).
case_images: Disease status after neoadjuvant chemotherapy plus immunotherapy and chemotherapy plus EGFR-TKI. (A) After two cycles of neoadjuvant chemotherapy plus immunotherapy, the size of the lung field from the right hilum to the right upper lobe of the lung large cystic solid mass was 6.6 x 4.6 x 6.0 cm. (B) After one cycle of neoadjuvant chemotherapy plus EGFR-TKI, the size of the lung field from the right hilum to the right upper lobe of the lung large cystic solid mass was 6.2 x 3.5 x 5.5 cm.
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case_images: Upon NGS analysis of the biopsy tissue sample, the patient was identified to harbor EGFR mutations (EGFR exon21 p.L861Q, EGFR exon18 p.G719C) ( Supplementary Figure 2 ), TP53 mutation (exon8 p.R273C), BCORL1 amplification, and CCNE1 amplification. After two cycles of chemotherapy plus immunotherapy, on October 27, 2021, a chest computed tomography (CT) scan showed that the size of the lesion in the lung field from the right hilum to the right upper lobe was 6.6 x 4.6 x 6.0 cm, and the largest enlarged lymph node was 1.5 x 1.3 cm, but the lesion was still close to the mediastinum and the main pulmonary artery, which was difficult to be surgically removed ( Figure 2A ). October 30th, 2021. On December 6, 2021, after one cycle of chemotherapy plus EGFR-TKI, a chest CT scan showed that the size of the lesion in the lung field from the right hilum to the right upper lobe was 6.6 x 4.6 x 6.0 cm, and the largest enlarged lymph node was 1.7 x 0.8 cm ( Figure 2B ).
case_images: Postoperative pathology of the patient after neoadjuvant chemotherapy plus EGFR-TKI showed pathological complete response.
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case_images: Postoperative pathology showed no residual tumor cells in the right upper lung lesion, no residual tumor cells in the resection margins of the trachea and blood vessels, and no tumor metastasis in the lymph nodes, reached pathological complete response (pCR) ( Figure 3 ).
case_images: Disease status after surgical resection. The chest CT scan showed no evidence of malignant tumor recurrence about (A) 2.5 months and (B) 5.5 months after surgical resection.
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case_images: On February 27th and May 23th, 2022, about 2.5 months and 5.5 months after surgical resection, chest CT scan showed no evidence of malignant tumor recurrence ( Figures 4A, B ).