case_images: PMC11754271_01
case_images: (A) Pathological findings at diagnosis. (B) serum biomarkers during treatment. (C) CT findings during treatment computed tomography.
case_images: fimmu-15-1473578-g001.jpg
case_images: PMC11754271_01_fimmu-15-1473578-g001.jpg
case_images: f1
case_images: SYN(focally+), CK(focally+), P53(strongly+),3 5BH11(focally+), CAM5.2(sporadically+), EBER-ISH(-), Vimentin(+) and SMARCA4 (-) (shown in  Figure 1A ). Moreover, serum biomarker examination for lung cancer were abnormal as follows: carcinoembryonic antigen (CEA) at 13.74 ng/mL, cytokeratin 19 fragment (CYFRA21-1) at 6.82 ng/mL, neuron-specific enolase (NSE) at 25.49 ng/mL, and progastrin-releasing peptide precursor (ProGRP) at 89.35 pg/mL (shown in  Figure 1C ). Immune function test yielded as follows: total CD3 count at 835cell/muL, CD4 count at 356cell/muL, CD8 count at 449cell/muL, CD4/CD8 ratio at 1.26, NK count at 369cell/muL, CD19 count at 170cell/muL, CD45 count at 1378cell/muL. Subsequent enhanced CT scans of the chest and abdomen revealed multiple metastases in the mediastinum, supraclavicular lymph nodes, ribs, left adrenal gland, and the lung. Throughout the follow-up period, the patient exhibited a favorable response to treatment, with serum biomarkers returning to normal levels and a marked improvement in immune function ( Figure 1B ). CT scan in February 2023 revealed enlarged lymph nodes in the pancreas and abdominal cavity ( Figure 1C ). Consequently, the patient was transferred to sintilimab 200mg (every 3 or 4 weeks per cycle) and anlotinib 12mg (daily with a 2-week on/1-week off regimen per cycle) till he died for suspected cardiovascular sequelae of the COVID-19 in September 2023.