case_images: PMC11286495_01
case_images: Chest computed tomography (CT) pulmonary window (A) and mediastinal window (B) revealed a soft tissue density nodule with a size of approximately 1.1 cm x 1.0 cm in the upper lobe of the left lung (arrows); no obvious lobulation or spiculation were found, which showed significant enhancement on the contrast-enhanced scan (C, arrow).
case_images: fmed-11-1437597-g001.jpg
case_images: PMC11286495_01_fmed-11-1437597-g001.jpg
case_images: fig1
case_images: On the same day, a chest CT revealed a soft tissue density nodule with a size of approximately 1.1 cm x 1.0 cm in the upper lobe of the left lung, which showed significant enhancement on contrast-enhanced scan (Figure 1), suspected to be lung cancer.
case_images: (A-D) Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT imaging of the patient; The maximum intensity projection (MIP, A) showed a significantly increased 18F-FDG uptake in the left lung (black arrow) and a moderately increased 18F-FDG uptake in the right lung (red arrow). Moreover, multiple nodules with increased 18F-FDG uptake were also seen in the mediastinum region (asterisk arrow), which were later pathologically confirmed as inflammatory lymph nodes. Axial CT (B), PET (C), and PET/CT fusion (D) show that the nodule with significantly increased 18F-FDG uptake on the left side was located in the upper lobe of the left lung (black arrows), with an SUVmax of 8.8, and the lesion with moderately increased 18F-FDG uptake on the right side was the right rib fracture (red arrows).
case_images: fmed-11-1437597-g002.jpg
case_images: PMC11286495_01_fmed-11-1437597-g002.jpg
case_images: fig2
case_images: The results showed significantly increased 18F-FDG uptake of the left upper lobe nodule (Figure 2), and multiple enlarged lymph nodes with increased uptake of 18F-FDG were observed in the mediastinum, suggesting the possibility of left upper lobe lung cancer with mediastinal lymph node metastasis.
case_images: (A) Hematoxylin-eosin staining showed that the tumor tissue was epithelial, and some areas were arranged in a papillary manner with mucous secretion. Immunohistochemistry showed tumor cells positively expressed CK (B), CK5/6 (C), CK7 (D), P63 (E), and TTF1 (F). All images are 100 x magnification.
case_images: fmed-11-1437597-g003.jpg
case_images: PMC11286495_01_fmed-11-1437597-g003.jpg
case_images: fig3
case_images: The immunohistochemical results showed that tumor cells expressed cytokeratin (CK), CK5/6, CK7, P63, and thyroid transcription factor 1 (TTF1) positively (Figure 3).