case_images: PMC10471885_01
case_images: MRI of fibular lesion. (A) MRI highlights of fibular lesion at the time of initial diagnosis. (B) MRI presentation of fibular lesion after two cycles of treatment.
case_images: fonc-13-1238331-g001.jpg
case_images: PMC10471885_01_fonc-13-1238331-g001.jpg
case_images: f1
case_images: Magnetic resonance imaging (MRI) revealed an occupying lesion in the middle fibular segment, suggesting a tumor ( Figure 1A ). HE staining revealed an adenoid growth pattern, as well as heterogeneous characteristics and nuclear atypia typical of lung adenocarcinoma ( Figure S1A ). Figures S1B-F ). The Ki-67 positivity rate was 70%, which indicated metastatic lung adenocarcinoma. Furthermore, to provide a more comprehensive assessment of bone metastasis, we have refined the results of the Tc-99 m bone scintigram. On MRI, the size of the fibular mass had decreased compared with that before ( Figure 1B ).
case_images: Chest computed tomography (CT) and prostate magnetic resonance imaging (MRI) scan of the patient throughout the course of diagnosis and treatment. (A-C), Imaging changes of chest CT (mediastinal window and pulmonary window) and prostate MR at different time points (D-F).
case_images: fonc-13-1238331-g002.jpg
case_images: PMC10471885_01_fonc-13-1238331-g002.jpg
case_images: f2
case_images: Subsequent chest computed tomography (CT) presented an occupying lesion in the lower lobe of the left lung, multiple small nodules in both lungs, and enlarged lymph nodes in the bilateral hilar mediastinum ( Figure 2A ), indicating metastatic tumors or multiple metastases. Further, MRI evaluation and PSA tests confirmed a prostate mass invading the seminal vesicle and posterior bladder wall, forming a soft tissue mass protruding into the bladder cavity ( Figure 2D ). It reveals abnormal metabolic activity in the lower cervical spine, left 9th rib articulation, 8th thoracic vertebra, and upper segment of the right tibia ( Figure S2 ). On December 14, 2022, chest CT revealed that the lesion in the lower lobes of the left and right lungs had shrunk compared with that observed on the previous scans ( Figure 2B ). Prostate MRI also presented a reduction in tumor size ( Figure 2E ). On February 13, 2023, upon re-examination with CT, the nodule in the lower lobe of the left lung had slightly decreased compared with that before, and the nodule in the right lung had significantly decreased, almost reaching complete remission ( Figure 2C ). Prostate MRI indicated that the size of the tumor had further reduced ( Figure 2F ).
case_images: Lung puncture pathology results. (A, D) HE revealed lung adenocarcinoma and prostate cancer histology (20x) and (200x). (B, C, E, F) The immunohistochemical examination indicated malignant cells immunoreactive for NapsinA (B); TTF-1 (C); NKX3.1 (E) and PSA (F). Magnification 100x.
case_images: fonc-13-1238331-g003.jpg
case_images: PMC10471885_01_fonc-13-1238331-g003.jpg
case_images: f3
case_images: The results of the hematoxylin and eosin (HE) staining revealed the presence of two distinct tumor cell types in the same field of view ( Figures 3A, D ). Additionally, notable differences in the expression of TTF-1, Napsin A, NKX3.1, and PSA were observed between the two tumor types ( Figures 3B, C, E, F ).
case_images: Prostate biopsy pathology results. (A) HE revealed prostate cancer histology. (B-D) The immunohistochemical examination indicated malignant cells immunoreactive for NKX3.1 (B) and negative expression for TTF-1 (C) and NapsinA (D). Magnification 100x.
case_images: fonc-13-1238331-g004.jpg
case_images: PMC10471885_01_fonc-13-1238331-g004.jpg
case_images: f4
case_images: HE staining also confirmed prostatic acinar adenocarcinoma ( Figure 4A ). A ( Figures 4B-D ). A puncture was made on the fibula mass.