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(a) and (b) Before right upper lobectomy. (a) Chest computed tomography (CT) with a 15.6-mm nodule (arrow) localized in the right upper lobe. (b) Fluorodeoxyglucose-positron emission tomography (FDG-PET) CT with a nodule (arrow) localized in the right upper lobe without distant metastasis. (c)-(e) Postoperative FDG-PET CT. FDG uptake is seen in mediastinal lymph nodes (c), bone (d), and liver (e). (f)-(h) CT after erlotinib and ramucirumab therapy. A new pulmonary lesion (f) and some liver lesions (g) and (h) are seen
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A 77-year-old woman underwent resection of right upper lobe non-small cell lung cancer (NSCLC) a year earlier (Figure 1a,b ). The NSCLC recurred with multiple lymph node, bone, and liver metastases 9 months earlier (Figure 1c-e), and L858R point mutation was identified. After a partial response for 9 months, follow-up chest-abdomen computed tomography (CT) showed a new pulmonary lesion in the left lower lobe and liver (Figure 1f-h).
(a) Echo-guided percutaneous needle biopsy was performed. 18-G needle (arrow). A subpleural hypoechoic mass (asterisk). (b) After the biopsy, computed tomography (CT) shows no pneumothorax, hemothorax, or air emboli, but a localized ground-glass opacity is seen around the mass.
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A subpleural hypoechoic mass was observed (Figure 2a). CT showed no pneumothorax, hemothorax, or air emboli, but a localized ground-glass opacity was seen around the mass (Figure 2b), which was judged to be due to hemoptysis after puncture.
Lung tissue from the echo-guided percutaneous needle biopsy. Grocott stain shows pulmonary cryptococcosis.
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Fungi showing positive Grocott staining confirmed pulmonary cryptococcosis (Figure 3).
Three months after the start of fluconazole, with no chemotherapy administered for the lung cancer during this period. (a) The lung nodules have shrunk and (b) the liver metastases have enlarged.
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Three months after having taken fluconazole, chest-abdomen CT showed that the left lower pulmonary lesion had shrunk (Figure 4a), and the liver lesions had enlarged (Figure 4b).