case_images: PMC9393296_01
case_images: Diagnosis of lung adenocarcinoma using PET and pathology. (A) PET-CT scan revealing active metabolic activity in the right lower lobe of the lung, multiple lymph nodes, adrenal gland, pleura and thyroid. (B) PET-CT image of thyroid and lung lesions. (C) Pathological image of lymph node biopsy confirming lung adenocarcinoma.
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case_images: A positron emission tomography-computed tomography (PET-CT) scan showed active metabolic activity in the right lower lobe of the lung, multiple lymph nodes, adrenal gland, pleura, and thyroid per the cancer manifestation ( Figures 1A, B ). A ( Figure 1C ) and negative for CK20, TG, AFP, HepPar1, GPC-3, GATA-3, CD56, CgA, and Syn, which supported the diagnosis of metastasis from lung adenocarcinoma. As TTF-1 is also a marker of thyroid cancer marker, and PET-CT also showed metabolic activity in the thyroid gland.
case_images: Diagnosis of colon metastasis from lung adenocarcinoma. (A) PET-CT scan showed the effects of first-line immunochemotherapy. (B) Representative PET-CT image of colon metastasis. (C) Pathological image of postoperative colon mass notarized colon metastasis of lung adenocarcinoma.
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case_images: However, the lesions in the distal ileum, ileocecum, and ascending colon occurred concomitant with bone metastases ( Figures 2A, B ). Subsequent histopathology revealed that ileocecal and colonic masses were moderately differentiated adenocarcinomas that exhibited positive immunoreactivities for CK7, napsin A, TTF-1, and Villin but were negative for CK20 ( Figure 2C ).
case_images: PD-L1 expression and timeline. (A) PD-L1 expression in lymph node biopsy tissues. (B) PD-L1 expression in the postoperative colon mass specimen. (C) Timeline of accessory examination adverse events and their management during treatment.
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case_images: However, we detected the BRAF V600E mutation and high programmed death-ligand 1 (PD-L1) expression (tumor proportion score >= 50%) ( Figure 3A ). BRAF V600E mutation was also present in the postoperative specimen, and PD-L1 was also highly expressed during testing ( Figure 3B ). Based on the above results, the patient was diagnosed with lung adenocarcinoma with colon, multiple lymph node, and multiple bone metastases. Based on the BRAF V600E mutation, she received dabrafenib plus trametinib as second-line therapy ( Figure 3C ).