case_images: PMC11693097_01
case_images: Magnetic resonance imaging revealed a nodule with edematous changes in the surrounding region in the right frontal lobe of the brain (white arrowheads) (a). Another nodule with edematous changes in the surrounding region in the inferior pole of the left temporal lobe (b) was also observed (white arrowheads). Those nodules (c, d) became reduced in size after SRT and first-line pem-len treatment (black arrowheads).
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case_images: Magnetic resonance imaging revealed a nodule with edematous changes in the surrounding region of the right frontal lobe of the brain (Fig. 1a). Another nodule with edematous changes in the surrounding region in the inferior pole of the left temporal lobe (Fig. 1b) was also observed. Three months after the initiation of treatment, both nodules in the brain had decreased in size, and edema in the surrounding regions also improved (Fig. 1c,d); symptoms also completely disappeared.
case_images: Computed tomography revealed a heterogeneous contrast-enhanced mass in the right kidney (a) (white arrowheads). Enlargement of the mediastinal lymph nodes (b) (white arrowheads) and multiple nodules in both lungs (c) (white arrowheads) were observed. Such lesions (d, e) became reduced in size (black arrowheads) after first-line pem-len treatment and multiple lung nodules completely disappeared (f).
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case_images: Computed tomography revealed a heterogeneous contrast-enhanced mass in the right kidney (Fig. 2a). The enlargement of mediastinal lymph nodes (Fig. 2b) and multiple nodules in both lungs (Fig. 2c) was observed. In addition, the mass in the right kidney (Fig. 2d) as well as mediastinal lymph nodes all decreased in size (Fig. 2e); the multiple nodules in the lungs disappeared (Fig. 2f).
case_images: HE stains of a bronchoscopic biopsy specimen (a) that was negative for cytokeratin 7 (b), cytokeratin 20 (c), and TTF-1 (d) and positive for PAX8 (e). Hematoxylin-eosin stain of a needle biopsy sample from the right kidney revealed the infiltration of atypical cells with clear cytoplasm and nuclei with increased chromatin (f).
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case_images: Pathological findings revealed atypical cells with nuclei showing increased chromatin (Fig. 3a) that stained negative for cytokeratin 7 (Fig. 3b), cytokeratin 20 (Fig. 3c), and TTF-1 (Fig. 3d) and positive for PAX8 (Fig. 3e). In addition, pathological findings from a needle biopsy in the right kidney revealed the infiltration of atypical cells with a clear cytoplasm and nuclei with increased chromatin (Fig. 3f).
case_images: Treatment course of the patients.
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case_images: However, these were controlled by an adequate suspension or reduction in dose of drugs and, finally, by achieving a tolerance for continuing with 10 mg every other day of lenvatinib (Fig. 4).