case_images: PMC9659857_01
case_images: CT appearance across the therapeutic process. (A) Thoracoabdominal CT at diagnosis (after thoracoabdominal drainage); (B) 1 month after almonertinib treatment; (C) hydrothorax and ascites appeared after almonertinib resistance (after thoracoabdominal drainage); (D) hydrothorax and ascites disappeared 1 month after afatinib plus cetuximab treatment. The solid blue arrow indicates the primary lesion; the open blue arrow indicates the hydrothorax; the solid red arrow indicates the malignant ascites; the open red arrow indicates the greater omentum metastasis.
case_images: fonc-12-995624-g001.jpg
case_images: PMC9659857_01_fonc-12-995624-g001.jpg
case_images: f1
case_images: Thoracoabdominal computed tomography (CT) ( Figure 1A ) and a radionuclide bone scan showed a 2.8-cm right upper lung mass, hydrothorax, ascites and multiple bone metastases (skull, right clavicle, multiple vertebrae, and pelvis). Stable disease was achieved initially, but the patient ultimately experienced progressive disease (appearance of hydrothorax and ascites), with a progression-free survival (PFS) time of 12 months ( Figures 1B, C ). CT performed after 1 month showed stable lung and metastatic lesions, and the hydrothorax and ascites were well controlled ( Figure 1D ). The overall survival (OS) exceeded 21 months from the initial pathological diagnosis ( Figure 1  and  Supplementary Image 1 ).
case_images: (A) Integrative Genomics Viewer snapshot of the L858R mutation in EGFR exon 21. (B) Integrative Genomics Viewer snapshot of the L718Q mutation in EGFR exon 18.
case_images: fonc-12-995624-g002.jpg
case_images: PMC9659857_01_fonc-12-995624-g002.jpg
case_images: f2
case_images: Mutations were detected in EGFR exon 21 (L858R) (abundance: 14.5%) and PIK3CA exon 8 (E474D) (abundance: 36.6%), as shown in  Figure 2A . A repeat examination for gene mutations was performed on the ascites sediment (Geneseeq, Nanjing, China), and mutations in EGFR exon 21 (L858R) (abundance: 1.7%), EGFR exon 18 (L718Q) (abundance: 0.8%) and TP53 (V157F) (abundance: 1.6%) were found ( Figure 2B ).