PMC6395856_01
Findings of chest computed tomography (CT) before and after treatment with pembrolizumab. (A) Chest CT shows a 60-mm irregularly shaped peripheral mass in the left upper lobe. (B) Chest CT shows a 10-mm irregularly shaped peripheral nodule in the right lower lobe. (C, D) After treatment with pembrolizumab for 13 cycles, the size of the left lesion dramatically decreased, but the size of the right lesion significantly increased.
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A 71-year-old woman presented with a chest computed tomography (CT) finding of left upper (Fig. 1A) and right lower (Fig. 1B) lung field nodules. After 13 cycles of pembrolizumab every 3 weeks, chest CT revealed a dramatic decrease in the size of the lesion in the left upper lobe (Fig. 1C), but the size of the lesion in the right lower lobe was significantly increased (Fig. 1D).
Endobronchial ultrasound with a guide sheath (EBUS-GS) and computed tomography-guided transthoracic needle biopsy (CTNB). (A) EBUS-GS was performed on the left upper lesion under X-ray fluoroscopy guidance. (B) CTNB was performed on the right lower lesion.
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Left upper lung field nodule was diagnosed by endobronchial ultrasound with a guide sheath as squamous cell carcinoma with high programmed death-ligand 1 (PD-L1) expression (70%) (Fig. 2A). 18F-fluoro-2-deoxyglucose positron emission tomography showed uptake in both nodules. Because the treatment effect differed between the bilateral lung lesions, a definitive right lower lung nodule diagnosis was obtained with CT-guided transthoracic needle biopsy (CTNB) (Fig. 2B).
Pathological specimens from computed tomography-guided transthoracic needle biopsy (CTNB) and surgical procedure. (A) Photomicrographs of the CTNB right lower lesion specimens show squamous cell carcinoma with marked eosinophilic infiltration. (B) Surgically operated right lower lesion specimens after treatment with benralizumab show markedly reduced eosinophilic infiltration.
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The eosinophil count in surgical tissue was markedly reduced compared with that in preoperative CTNB tissue (Fig. 3A and B).