case_images: PMC11813057_01
case_images: Image examination results. (A) CT showed perihilar lesions in the upper lobe of the right lung with distal obstructive pneumonia, invasion into the adjacent structures of the mediastinum, multiple metastases in the right and left lungs, multiple metastatic lesions in the liver. (B) Bone imaging revealed abnormal increases in the radioactivity of the skull, sternum, cervical, thoracic, lumbar and sacral vertebral bodies, multiple ribs on both sides, scapula, pelvis and lower limbs. CT = computed tomography.
case_images: medi-104-e41290-g001.jpg
case_images: PMC11813057_01_medi-104-e41290-g001.jpg
case_images: F1
case_images: Plain and contrast-enhanced chest and upper abdominal computed tomography scans revealed perihilar lesions in the upper lobe of the right lung with distal obstructive pneumonia, invasion into the adjacent structures of the mediastinum, multiple metastases in the right and left lungs, possible lymph node metastasis in the mediastinum and right hilar lung, pleural effusion and a slightly thickened pleura in the right lung and multiple metastatic lesions in the liver (Fig. 1A). Whole-body bone imaging revealed abnormal increases in the radioactivity of the skull, sternum, cervical, thoracic, lumbar and sacral vertebral bodies, multiple ribs on both sides, scapula, pelvis and lower limbs, which indicated extensive bone metastasis (Fig. 1B).
case_images: Immunohistochemical results of the cells stripped by drainage fluid. (A-F) Immunohistochemistry results, respectively, HE, Ki-67 (50%+), CK (AE1/AE3) (+), CK5/6 (-), p40 (+), and TTF-1.
case_images: medi-104-e41290-g002.jpg
case_images: PMC11813057_01_medi-104-e41290-g002.jpg
case_images: F2
case_images: According to the results of exfoliative cytology of drainage fluid and immunohistochemistry [CK (AE1/AE3) (+), CK56 (-), CD68 (-), CD45 (LCA) (-), TTF-1 (+), p40 (+), D2-40 (-), and ki-67 (50%+)], adenocarcinoma of lung origin was considered (Fig. 2A-F).
case_images: Second-generation sequencing. ERBB2 (EXON20.p.Y772-A775dup) and TP53 (EXON5.c.404G-Tp.C135F) mutations.
case_images: medi-104-e41290-g003.jpg
case_images: PMC11813057_01_medi-104-e41290-g003.jpg
case_images: F3
case_images: TP53 (EXON5.c.404G-Tp.C135F) mutations (Fig. 3). The patient received 6 cycles of chemotherapy regimen comprising bevacizumab + pemetrexed + carboplatin.
case_images: Response evaluation. The soft tissue shadow near the pulmonary portal in the upper lobe of the right lung decreased, the right pleural effusion had no significant changes, and the metastatic lesions in the liver had no significant change.
case_images: medi-104-e41290-g004.jpg
case_images: PMC11813057_01_medi-104-e41290-g004.jpg
case_images: F4
case_images: On December 28, 2023, and February 25, 2024, the patient was assessed to evaluate treatment efficacy, and he then achieved stable disease (SD) (Fig. 4A and B).
case_images: Course and treatment of patient.
case_images: medi-104-e41290-g005.jpg
case_images: PMC11813057_01_medi-104-e41290-g005.jpg
case_images: F5
case_images: The course and treatment flow chart of patients (Fig. 5).