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case_images: PMC11798969_02
case_images: (A) The patient's initial CT scan shows diffuse nodules in the lungs. (B): The patient's initial CT scan indicates enlarged mediastinal lymph nodes.
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case_images: Despite only slight symptomatic relief from anti-inflammatory drugs at a community hospital, a CT scan on March 22, 2024, revealed diffuse nodules in both lungs and enlarged lymph nodes, suggesting a malignant tumor ( Figure 1 ).
case_images: Lung biopsy pathology suggests adenocarcinoma with neuroendocrine differentiation.
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case_images: A lung biopsy on March 28, 2024, confirmed non-small cell lung cancer, specifically adenocarcinoma with neuroendocrine differentiation, based on Immunohistochemistry (IHC) ( Figure 2 ).
case_images: Imaging changes of the pituitary gland in the patient after using Sintilimab. (A) shows the coronal view of the pituitary T2 signal, and (B) shows the sagittal view of the pituitary T1 signal. Description of the pituitary MRI with plain and contrast: The sella turcica has a regular shape with no depression of the sellar floor, and no significant abnormal signal in the bone of the sella, there is a slight exudate-like change around the pituitary, about 7mm in height, and a nodule-like isointense slightly long T1 and slightly long T2 signal can be seen on the left side of the pituitary, which shows mild enhancement (lower than the adjacent normal pituitary tissue), with a long diameter of about 4mm, the pituitary stalk is slightly deviated to the left, with no significant abnormal signal. The bilateral cavernous sinus structure is clear, and the signal is not significantly abnormal, there is no obvious sign of compression and upward displacement of the optic chiasm, a circular short T1 and slightly long T2 signal can be seen in the left sphenoid sinus, which shows high signal on enhancement, with a clear edge; multiple isointense slightly long T1 and slightly long T2 signals can be seen in the brain tissue, with ring-like and nodular enhancement.
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case_images: A magnetic resonance scan with plain and enhanced imaging of the pituitary gland indicated abnormal signal on the left side of the pituitary, diagnosing pituitary metastasis (see  Figure 3 ).
case_images: Changes in the patient's urine volume.
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case_images: After 2 days of use, the urine volume decreased from 5600ml to 3200ml (see  Figure 4 ), and the patient's thirst symptoms and facial palsy showed slight improvement.
case_images: Changes in the patient's facial appearance before and after steroid treatment (left image is before treatment, right image is after treatment).
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case_images: A follow-up phone call after half a month, the family reported that the urine volume had returned to normal (see  Figure 5  for changes in the patient's face before and after treatment, and  Figure 6  for the treatment course).
case_images: Timeline of the patient's treatment.
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case_images: A follow-up phone call after half a month, the family reported that the urine volume had returned to normal (see  Figure 5  for changes in the patient's face before and after treatment, and  Figure 6  for the treatment course).