case_images: PMC11317239_01
case_images: Sequential CT scan evaluation and histological examination analysis in this case report. (A) Pelvic puncture tissue biopsy. The CT scan image on June 2018 (B), October 2018 (C), April 2020 (E), April 2021 (F), June 2021 (G), and July 2022 (H). (D) The PET-CT scan on August.
case_images: fphar-15-1359403-g001.jpg
case_images: PMC11317239_01_fphar-15-1359403-g001.jpg
case_images: F1
case_images: A contrast-enhanced CT (CECT) scan further confirmed the presence of a nodule in the left lower lobe (Figure 1B). Hematoxylin and eosin staining of the excised tumor mass confirmed a stage IIIA infiltrating lung adenocarcinoma of the solid predominant subtype (Figure 1A), with carcinoma metastasis in regional lymph nodes. Four months after initiating targeted therapy, imaging showed no tumor lesions in situ, confirmed by the negative results of non-invasive liquid biopsy sequencing conducted 2 months later (Figure 1C; Table 1). After 13-month treatment of erlotinib, the PET-CT indicated intense FDG activity in nodules located in the inferior lobe of the left lung near the hilar, suggesting intrapulmonary lymph node metastases (Figure 1D). Osimertinib was tentatively employed as second-line treatment in September 2019, with significant tumor reduction observed 7 months later (Figure 1E). August 2020 (10-month after initiating osimertinib) to control pleural effusions, administered monthly. After 19 months of osimertinib treatment, the patient developed new nodules and exhibited obviously increased bilateral pleural effusions, suggesting potential disease recurrence (Figure 1F). One month later, a CECT assessment showed alleviated tumor lesion, decreased pleural effusions, and reduced nodules sizes (Figure 1G). At the last follow-up in July 2022, CT scans showed resolved pleural effusions (Figure 1H), and serum marker levels remained within normal range.
case_images: Timeline of events and detected mutations of this case report.
case_images: fphar-15-1359403-g002.jpg
case_images: PMC11317239_01_fphar-15-1359403-g002.jpg
case_images: F2
case_images: On 11 June 2018, with informed consent, this patient underwent a left lung lobotomy and complete mediastinal lymphadenectomy (Figure 2).