case_images: PMC10618749_01
case_images: Chest CT at diagnosis (A) and 20 days after starting of chemotherapy (B). A: Chest CT at diagnosis showed multiple nodules in the right lower lobe (arrows) and subcarinal lymphadenopathy (arrowhead). B: Chest CT at 20 days after starting chemotherapy. Both the lung nodules and the lymph node metastasis were reduced in size (arrowhead).
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case_images: A chest computerized tomography (CT) scan revealed mediastinal and right hilar lymphadenopathy, and multiple nodules in the right subpleura (the maximum tumor diameter was 41 mm) [Fig. 1A]. At 20 days after starting chemotherapy, a chest CT scan revealed a reduction of tumor size (reduction rate: 67%; Fig. 1B).
case_images: Repetitive nerve stimulation test.. A: The compound muscle action potential (CMAP) by single-pulse nerve stimulation of the left ulnar nerve in rest. The CMAP amplitude was 0.38 mV. B: The CMAP of single-pulse nerve stimulation for the left ulnar nerve after 10 seconds of exercise. The CMAP amplitude was increase to 7.75 mV. C: The repetitive nerve stimulation test in the abductor digiti minimi muscle shows the waning phenomenon with 3-Hz repetitive stimulations of the left ulnar nerve. The 10th amplitude of the CMAP was decreased by 34% compared to that of the first CMAP.
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case_images: In the nerve conduction study, the first compound muscle action potential (CMAP) amplitude by single-pulse nerve stimulation during rest was small (0.38 mV), whereas the amplitude immediately after 10 seconds of exercise was markedly increased to 7.75 mV (Fig. 2A and B). In a 3 Hz repetitive nerve stimulation test of the left ulnar nerve, a 34% decrement was observed under the resting condition (Fig. 2C).
case_images: Changes in pro-gastrin releasing peptide (Pro-GRP) level, serum sodium level and manual muscle testing (MMT) score. Patient had chemotherapy on day 8 after admission. After cisplatin and irinotecan treatment, the Pro-GRP level, serum sodium level, and MMT score changed from 276 pg/ml to 112 pg/ml, from 127 mEq/L to 134 mEq/L, and from 3 to 4, respectively during the 28-days interval.
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case_images: Systemic chemotherapy was initiated using a platinum-doublet chemotherapy regimen based on irinotecan (60 mg/m2, days 1, 8 and 15, intravenously) and cisplatin (60 mg/m2, day 1, intravenously) every 21 days as a first-line treatment immediately following diagnosis (Fig. 3).