PMC9646958_01
Changes in Computerized Tomography Images. (A) The bronchus of the lower lobe of the right lung was truncated from hilus of lung, and the basal segment of the lower lobe of the right lung was clumped with consolidation shadow and obstructive atelectasis. (B) Obstructive pneumonia and atelectasis were worse after one-cycle treatment of bevacizumab combined with albumin-bound paclitaxel and carboplatin. (C, D) The mass in the lower lobe of the right lung was significantly reduced, obstructive pneumonia and atelectasis were significantly improved after PD1 and chemotherapy. (E)After treatment, there were multiple consolidation shadows, ground glass shadows and interstitial changes in chest CT, which was considered as immune checkpoint inhibitor-associated pneumonia. (F, G). After three months of methylprednisolone administration, the tumor near the pleura in the lower lobe of the right lung progressed slightly, and the immune pneumonia was not completely resolved. (H, I) After anlotinib treatment, the tumor near the pleura in the lower lobe of the right lung was stable.
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An enhanced CT scanning was performed, indicating malignant lesions in the right lower lobe of the lung with obstructive pneumonia and atelectasis, truncation of the proximal bronchus, invasion of the right pulmonary vein, and multiple ground-glass nodules in both lungs ( Figure 1A ). Re-examination with chest CT showed that obstructive pneumonia and atelectasis were worse than before ( Figure 1B ). After one cycle of treatment, the tumor in the lower lobe of the right lung showed a trend of shrinkage ( Figure 1C ). However, multiple consolidation shadows, ground glass shadows, and interstitial changes emerged along with tumor shrinking ( Figures 1D, E ). On March 3, 2022, chest CT showed mild tumor progression near the pleura in the lower lobe of the right lung and incomplete remission of immune pneumonia ( Figures 1F, G ). Therefore, a treatment regimen of oral anlotinib (12 mg d1-d14/21 d) was started, and the tumor was stable at the last review in May, 2022 ( Figures 1H, I ).
Pathological Findings. Poorly differentiated carcinoma, consistent with pulmonary sarcomatoid carcinoma. H&Ex200, hematoxylin and eosin stain.
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The pathological findings of the biopsy tissue suggested poorly differentiated PSC ( Figure 2 ).