case_images: PMC11217477_01
case_images: Histopathological characteristics of percutaneous lung biopsy. Microscopic examination reveals irregular nest-like structures of cancer cells with round nuclei, visible small nucleoli, abundant translucent and red-stained cytoplasm, accompanied by areas of necrosis (yellow arrows).
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case_images: TTF-1(-), CK7(-), Napsin A(-), and Ki67(+, 40%) ( Figure 1 ). PD-L1 expression in the tumor was negative. The patient had been a smoker for 40 years.
case_images: Timeline and CT/DR manifestation. (A) Chest imaging at initial hospitalization. (B) On the first day after the 3rd cycle of immunotherapy, a chest DR image revealed a potential new growth in the lower right lung with mild surrounding obstructive inflammation. (C) In the routine tumor follow-up PET-CT image, a right lower lung posterior basal segment cancer mass volume was similar to the 5 October CT image (A), but with reduced obstructive inflammation. (D) Chest DR image upon return for treatment: Reduced right lower lung mass and decreased surrounding inflammation compared to the 13 October DR image (B). (NSCLC, non-small cell lung cancer; HA, human albumin; CT, computed tomography; DR, digital radiography; PET-CT, positron emission tomography-computed tomography; Hb, hemoglobin; rhG-CSF, recombinant human granulocyte colony stimulating factor; IVIG, intravenous immunoglobulin).
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case_images: A repeat chest CT scan conducted on October 5 revealed a mass measuring approximately 6.1x5.2cm in the right lower lung posterior basal segment ( Figure 2A ), raising concerns of a new neoplasm, with mild perilesional inflammation evident. Table 1 ). Additionally, Digital Radiography (DR) findings on October 13 were consistent with the earlier CT results ( Figure 2B ). Follow-up positron emission tomography CT (PET-CT) on November 8 revealed that the tumor volume in the right lower lobe peripheral basal segment remained largely unchanged compared to the previous assessment( Figure 2C ). Chest CT revealed a decreased mass, measuring approximately 5.6x4.8 cm in the right lower lung, in comparison to the previous assessment, with a slight reduction in perilesional obstructive inflammation ( Figure 2D ).
case_images: Dynamic changes in the routine blood test. (HA, human albumin; WBC, white blood cell count; ANC, absolute neutrophil count;MP, methylprednisolone; IVIG, intravenous immunoglobulin; Hb, hemoglobin; rhG-CSF, recombinant human granulocyte colony stimulating factor).
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case_images: f3
case_images: Soon after midnight he developed a fever with a peak temperature of 40.2 C and exhibited a WBC level of 1.3x109/L with an ANC of 0x109/L indicating agranulocytosis ( Figure 3 ). Approximately 10 days after the third administration of combined sintilimab therapy, the neutrophil count returned to normal, and no fever was observed ( Figure 3 , it is noted that no statistical analysis was employed for the comparison between the lines).