case_images: PMC4427142_01
case_images: Contrast-enhanced CT scans revealed a right lung tumor with a size of 15 mm and multiple lymph node metastases (arrows).
case_images: crg-0009-0081-g01.jpg
case_images: PMC4427142_01_crg-0009-0081-g01.jpg
case_images: F1
case_images: Contrast-enhanced CT scans revealed a right lung tumor with a size of 15 mm and multiple lymph node metastases, pleural dissemination and a suspected left adrenal metastasis (fig. 1).
case_images: a Contrast-enhanced CT scans showed only hepatomegaly without any intrahepatic nodular lesions. b An ultrasound sonography examination revealed only diffuse minimal high-echoic nodular shadows.
case_images: crg-0009-0081-g02.jpg
case_images: PMC4427142_01_crg-0009-0081-g02.jpg
case_images: F2
case_images: The liver findings only showed hepatomegaly without any intrahepatic nodular lesions when using contrast-enhanced CT (fig. 2a); diffuse minimal high-echoic nodular shadows were visible during ultrasound examination (fig. 2b).
case_images: a Cytology from a mediastinal lymph node by transbronchial needle aspiration revealed SCLC (x400). b Histological examination of the liver revealed diffuse liver metastases of SCLC, all of which were positive for chromogranin A, synaptophysin, CD56, TTF-1 and AE1/AE3 and with a Ki-67 index of 80% (hematoxylin and eosin: x40, x400; chromogranin A, CD56, TTF-1, AE1/AE3, Ki-67: x400).
case_images: crg-0009-0081-g03.jpg
case_images: PMC4427142_01_crg-0009-0081-g03.jpg
case_images: F3
case_images: Based on a transbronchial needle aspiration of a mediastinal lymph node, he was diagnosed as having stage IV SCLC (fig. 3a). TTF-1 and AE1/AE3 and with a Ki-67 index of 80% (fig. 3b). Thereafter, the patient's general condition and liver failure worsened quite rapidly, and best supportive care was selected.