case_images: PMC9379949_01
case_images: (a) Lung CT revealed: diffuse thickening of the bronchial wall. (b) CT showed the no
  tumor progression compared with that before. (c) CT showed no progression compared
  with that before. CT: Computed Tomography.
case_images: 10.1177_03946320221120962-fig1.jpg
case_images: PMC9379949_01_10.1177_03946320221120962-fig1.jpg
case_images: fig1-03946320221120962
case_images: Coronary test in Zhongshan Hospital Affiliated to Dalian University showed negative; blood routine: C-reactive protein (CRP): 76.69 mg/L (0-10) and serum amyloid A (SAA): 303.31 mg/L (0-10); the remaining tumor markers, urine and stool routine, blood lipid, D-dimer, coagulation, thyroid function, renal function, electrolytes, myocardial enzymes, troponin, and hepatitis virus series showed no significant abnormalities. Computed Tomography (CT) + enhancement revealed: diffuse thickening of the bronchial wall (see Figure 1(a)). Chest CT retest was performed on 20 February 2021 during chemotherapy period and no evidence of tumor progression showed (see Figure 1(b)). CT showed no clear signs of tumor metastasis, and brain MRI examination showed no signs of tumor metastasis. Contrast-enhanced CT of the chest showed no evidence of tumor progression showed (see Figure 1(c)).
case_images: (a) Bronchoscopy revealed that the bronchial mucosa on both sides was thickened and
  edematous, the surface was rough, each bronchus was narrow (see arrows), and the
  intervertebral ridges were widened(see dotted line). (b)Ultrasound endoscope: puncture
  the ruminal and right hilar lymph nodes.
case_images: 10.1177_03946320221120962-fig2.jpg
case_images: PMC9379949_01_10.1177_03946320221120962-fig2.jpg
case_images: fig2-03946320221120962
case_images: The ruminal lymph nodes and right hilar lymph nodes were explored by replacing the ultrasound endoscope, and 3 shots were given for each of the two groups of lesions under ultrasound guidance for histological and cytological examination (see Figure 2).
case_images: (A) (staining, H&E; magnification, x4) needle biopsy: atypical cells. (b)
  (staining, H&E; magnification, x200) needle biopsy: a small amount of atypical
  cells were observed. (c) Immunohistochemically (magnification, x200): CK (+). (d)
  Immunohistochemically (magnification, x200): TTF-1 (+). (e) Immunohistochemically
  (magnification, x200): CD56 (+). (f) Immunohistochemically (magnification, x200):
  Ki-67 (+60%).The yellow particles in the arrows in C-F are cancer cells, where the
  protein expression is positive. Considering small cell carcinoma in combination with
  immunohistochemical results.
case_images: 10.1177_03946320221120962-fig3.jpg
case_images: PMC9379949_01_10.1177_03946320221120962-fig3.jpg
case_images: fig3-03946320221120962
case_images: Special staining: acid-fast staining (-), methenamine silver (-), and PAS (-) (see Figure 3).