case_images: PMC11014720_01
case_images: a Left apical lung lesion with cystic appearance. b Hilar ipsilateral necrotic lymphadenopathy (10 L).
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case_images: PMC11014720_01_cro-2024-0017-0001-538019_F01.jpg
case_images: F1
case_images: Thoracic computed tomography (CT) scan showed two morphologically different bilateral lesions: a cystic left apical lesion measuring 6.1 cm x 5.3 cm x 4.5 cm with hilar ipsilateral necrotic lymphadenopathyc (Fig. 1) and a peribronchovascular centimetric solid retractile lesion associated with ground glass opacities (GGO) of 3 cm in the right upper lobe (Fig. 2).
case_images: a Squamous cell carcinoma. Arrow indicates intercellular bridge supporting a squamous differentiation (x200). Inset: p40 immunohistochemistry on the resected lung specimen, confirming the diagnosis of squamous cell carcinoma. b Lung adenocarcinoma (x200). Inset: TTF1 immunohistochemistry (x200). c Deletion c.3028+1_3028+5del in the splicing donor site of MET gene, leading to the splicing of exon 14 in MET gene in the squamous cell carcinoma (IGV viewer). d c.2573T>G mutation in EGFR gene, leading to a p.Leu858Arg amino acid change (IGV viewer) in the lung adenocarcinoma.
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case_images: PMC11014720_01_cro-2024-0017-0001-538019_F03.jpg
case_images: F3
case_images: Next-generation sequencing (NGS) analysis was performed for both lesions and revealed a mesenchymal-epithelial transition (MET) gene deletion with exon 14 skipping in squamous carcinoma and an epidermal growth factor receptor (EGFR) gene mutation in exon 21 (L858R) in adenocarcinoma (Fig. 3).
case_images: Timeline of main clinical events.
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case_images: PMC11014720_01_cro-2024-0017-0001-538019_F04.jpg
case_images: F4
case_images: The main clinical events are summarized in Figure 4.