case_images: PMC10711212_01
case_images: Tumor progression of the patient before and after treatment. (A) The timeline of therapies and tumor progression are indicated (Top). CT images revealed lesions in upper left lung. The tumor is indicated by red arrows. PFS, progression-free survival;SD, stable disease; PD, progressive disease; NGS, next-generation sequencing; mo., months. (B) Brain MRI scans revealed no metastasis at February 2023. (C) The EGFR exon21 c.T2573G p.L858R mutation was visualized by IGV software.
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case_images: PMC10711212_01_fonc-13-1279045-g001.jpg
case_images: f1
case_images: Subsequent shoulder joint X-ray revealed a shadow in the left upper lobe of the lung (Figure 1A). Furthermore, an enlarged right diaphragmatic lymph node was observed (Figure 1A). Subsequent CT-guided biopsy of the left upper lung revealed atypical giant cells within fibrous tissue (Figure 1A). The cranial magnetic resonance imaging (MRI) examination did not reveal any evidence of intracranial metastases (Figure 1B). The results revealed a clinically significant EGFR p.L858R-positive mutation (Figure 1C), accounting for an overall mutation rate of 5.68%. EGFR-TKI aumolertinib was chosen, with a daily dose of 110mg. Encouragingly, a follow-up chest CT after three months of aumolertinib treatment showed a significant reduction in the size of the tumor in the left upper lobe (4.4 x 1.9 cm) and the lymph node in the right cardiogenic angle (Figure 1A). Upon a follow-up examination in August, the tumor had decreased to 3.8x1.3cm, and the associated lymph nodes had also decreased in size (Figure 1A).
case_images: Hematoxylin and Eosin (HEx200) staining and immunohistochemistry (IHCx200) results. (A) HE staining indicates cytoplasmic acidophilia and nuclear basophilia, with evident intracellular cell proliferation features. (B) CK-7 (+). (C). NaspinA (+). (D) TTF-1 (+). (E) Ki67 (+, 5%). (F) p53 (+, 10%). (G) CK5/6 (-) (H). P40 (-) (I) VIM (-).
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case_images: PMC10711212_01_fonc-13-1279045-g002.jpg
case_images: f2
case_images: Immunohistochemical analysis further confirmed its pulmonary origin, with positive markers including CK(+), CK7(+), NaspinA(+), TTF-1(+), Ki67(+, 5%), p53(+, 10%), CK5/6 (-), P40 (-), and VIM (-) (Figures 2A-I).To assess the possibility of distant metastasis, the patient underwent positron emission tomography-computed tomography (PET-CT), which indicated elevated glucose metabolism in the left upper lobe tumor.