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case_images: Chest computed tomography (CT) findings. (A) Chest CT showing a round nodule-like shadow in the left upper lobe, with a clear boundary and shallow lobule of about 2.5 cm diameter. (B) After anti-infection treatment, the chest CT showed a high-density shadow in the tongue segment of the left lung, with a size of about 3.2 cm * 2.7 cm, likely to be neoplastic. (C) Chest CT showing a 5.3 cm * 3.5 cm tumor mass in the lingual segment of the left upper lobe. (D) The lesion in the left upper lobe was about 9.1 cm * 6.7 cm, with bubbles and liquid dark areas. After enhanced CT, the lesion showed circular enhancement. (E) Chest CT showing a mass of 8.8 cm * 8.0 cm in the upper lobe of the left lung, containing gas-liquid plane. (F) Chest CT showing a small nodular high-density shadow in the lower lobe of right lung with clear boundary and 1.2 cm diameter.
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case_images: On 2019-09-17, diagnostic chest enhanced computed tomography (CT) revealed nodules in the upper lobe of the left lung (Figure 1A). The 2019-10-21 review chest CT revealed a tongue segment mass in the left lung, suggestive of malignancy, and a micronodule in the upper lobe of the right lung (Figure 1B). On 2019-11-11, chest CT showed lesions occupying the space of the upper lobe tongue segment of the left lung, in addition, some inflammation and fibrous foci were also observed in the two lungs with tiny nodules in the anterior segment of the upper lobe of the right lung, and some effusion on both sides (Figure 1C). A lung abscess was considered, with obstructive pneumonia, and there was slight effusion in the thorax on both sides (the left more anterior) (Figure 1D). The right pleural effusion shadow was more absorbed, and the left pleural effusion shadow appeared more anterior (Figure 1E). China) due to a painless palpable mass in the right breast that had been present for two days (Figure 4). Chest CT showed left residual pneumonia with segmental atelectasis (less anterior), left pleural effusion, and small nodules in the right lung (Figure 1F).
case_images: Bronchoscopy revealing congestion and edema of the mucosa at the mouth of the left lingual duct.
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case_images: Bronchoalveolar lavage was given and bronchoscopy revealed congestion and edema of the mucosa at the mouth of the left lingual duct, and no obvious active bleeding (Figure 2).
case_images: Hematoxylin and eosin staining of a tumor section (x200). (A) Pathological examination under light microscopy, showing a poorly differentiated non-small cell carcinoma occupying the space of the upper lobe of the left lung. (B) Pathological examination under light microscopy, showing a poorly differentiated carcinoma of the right breast with extensive hemorrhagic necrosis. (C) Immunohistochemical staining for beta-hCG (positive in foci).
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case_images: The postoperative pathological assessment showed a poorly differentiated non-small cell carcinoma occupying the upper lobe of the left lung, consistent with large cell neuroendocrine carcinoma, with abscess formation, and reactive hyperplasia of 18 lymph nodes (Figure 3A). Routine pathology on 2020-02-12 showed poorly differentiated carcinoma of the right breast with extensive hemorrhagic necrosis (considering the high possibility of breast origin) with reactive hyperplasia of sentinel lymph nodes (two stations) (Figure 3B). Complementary breast tumor tissue immunohistochemistry showed hCG (+) (Figure 3C).
case_images: Breast ultrasound showing hypoechoic mass in the right breast (BI-RADS 4a) (green box).
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case_images: China) due to a painless palpable mass in the right breast that had been present for two days (Figure 4). Chest CT showed left residual pneumonia with segmental atelectasis (less anterior), left pleural effusion, and small nodules in the right lung (Figure 1F).
case_images: Chest computed tomography (CT) before and after chemotherapy. (A) Chest CT showing multiple nodules and masses in both lungs, the larger of which was about 5.7 cm * 3.4 cm. (B) Chest CT after chemotherapy showing tumors smaller than those before.
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case_images: On 2020-03-09, a review of the chest CT showed multiple metastases in both lungs, left residual pneumonia with segmental atelectasis, a little left pleural effusion, and left pleural hypertrophic adhesion (Figure 5A). The 2020-10-22 review chest CT scan showed that the shadow of the two lung nodules was significantly reduced compared with previous scans, and the shadows of the two lung patches were absorbed (Figure 5B).
case_images: Brain magnetic resonance imaging (MRI) before and after chemotherapy. (A) Brain MRI before chemotherapy shows multiple nodules in bilateral frontal lobe and right occipital lobe, suggesting metastasis with a little bleeding. (B) After chemotherapy, brain MRI shows that bilateral frontal lobe and right occipital lobe nodules were smaller than before, and the peripheral edema was relieved.
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case_images: The 2020-10-24 review head MRI, compared to that on 2020.03.11 (Figure 6A), showed remission of the metastases of the frontal lobe on both sides and of the occipital lobe on the right side compared to that on the anterior lobe (Figure 6B).