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case_images: The pathology of a mediastinal biopsy in 2011 showed thymic small cell carcinoma. (A and B) Hematoxylin and eosin (HE), (magnification 200x, 400x); (C-F) Immunohistochemistry: CD56+; CgA+; Syn+; Ki67 40%, (magnification 100x).
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case_images: A biopsy of the mediastinal lesions showed small cell carcinoma (Figure 1).
case_images: PET-CT scans in May 2017 showed soft tissue enlargement and chest wall metastasis. (A) Anterior mediastinal residual adjacent soft tissue density without increased FDG metabolism, representing local tumor biologic activity loss. (B) Bony destruction of the right 3rd and 4th anterior ribs and the adjacent sternum as well as the right 6th to 9th posterior ribs. (C) Corresponding parts of the right front chest wall soft tissue thickening.
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case_images: The patient felt sternal pain again in May 2017, and a positron emission tomography/computed tomography (PET-CT) scan showed progressive disease (PD) with right parasternal tissue enlargement and chest wall metastases (Figure 2).
case_images: Enhanced CT scans showed PD in March 2019 compared with prior imaging from June 2018. (A) Chest-enhanced CT scans showed multiple bone metastases with surrounding soft tissue masses in June 2018. (B-F) Enhanced CT scans in March 2019. (B) Right clavicle and neck lymph node metastases. (C) Soft tissue density shadow in the anterior mediastinum. (D) Enlarged soft tissue in the right chest wall. (E) Soft tissue image of the right spermatic cord. (F) Right testicular mass.
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case_images: During the follow-up period, the patient's response to chemotherapy was rated as SD (Figure 3A). An enhanced CT was performed which showed right clavicle and neck lymph node metastases, multiple new bone metastases with surrounding soft tissue masses, and right testicle metastases (Figure 3B-F).
case_images: Biopsy of the right parasternal mass showed thymic SCC. (A) Hematoxylin and eosin (HE), (magnification 100x); (B) HE, (magnification 200x); (C and D) Immunohistochemistry: CK5/6+; CKpan+; (magnification 100x).
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case_images: Interestingly, the pathology of the right parasternal mass biopsy showed SCC rather than small cell carcinoma (Figure 4).
case_images: Postoperative pathology of the right orchiectomy showed thymic SCC. (A) Hematoxylin and eosin (HE), (magnification 200x); (B-F) Immunohistochemistry: CD117+; CK5/6+; CKpan +; SALL-4-; P40+, (magnification 100x).
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case_images: Due to the size of the right testicular mass, a right orchiectomy was performed, and postoperative pathology also confirmed SCC from the thymus gland (Figure 5).
case_images: Enhanced CT scans of the chest before and after anlotinib therapy. (A) A soft tissue mass of the chest wall was significant before anlotinib therapy. (B) After three months of anlotinib treatment, a repeat enhanced chest CT showed that the soft tissue mass had become smaller. (C and D) After 8 and 21 months of anlotinib treatment, the soft tissue mass remained stable.
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case_images: The patient therefore achieved a PFS of 25 months during anlotinib treatment, and an OS of up to 10 years from diagnosis (Figure 6).
case_images: Timeline of disease status and the treatment.
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case_images: The patient's treatment timeline is shown in Figure 7.