case_images: PMC9816567_01
case_images: Chest computed tomography showing (A) primary lung cancer and bilateral pleural effusions and (B) pericardial effusion. (C, D) After drainage of the effusions and pleurodesis, showing control of the effusions before starting systemic chemotherapy.
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case_images: f1
case_images: C-reactive protein 0.97 mg/dL, pro-gastrin-releasing peptide 71.9 pg/mL, and neuron specific enolase 254 ng/mL. Chest computed tomography (CT) showed a mass shadow anterior to the left upper lobe, bilateral pleural effusions ( Figure 1A ), and pericardial effusion circumferentially around the entire heart ( Figure 1B ). Later, we performed talc pleurodesis to control the pleural effusion ( Figures 1C, D ) and improve the PS, which was 2 at the initial visit, and subsequently improved to 0.
case_images: Histopathological findings of the pulmonary tumor. (A) Hematoxylin and eosin staining showing dense sheet-like growth of bare nucleated atypical cells with increased chromatin (400x magnification). Immunostaining showing positive (B) insulinoma-associated protein 1 (400x magnification) and (C) chromogranin A (200x magnification).
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case_images: f2
case_images: Hematoxylin and eosin staining of the biopsy specimen revealed dense sheet-like growth of bare nucleated atypical cells with increased chromatin ( Figure 2A ), and immunostaining was positive for insulinoma-associated protein 1 ( Figure 2B ) and chromogranin A ( Figure 2C ) and negative for thyroid transcription factor-1, p40, and leukocyte common antigen (not shown).
case_images: Timeline of the main interventions from the initial visit to the treatment course.
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case_images: f3
case_images: The timeline of all relevant interventions from the initial visit to the introduction of treatment is shown in  Figure 3 .