PMC5414636_01
Tumor section staining with hematoxylin and eosin (400x).
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On September 28, 2014, adenocarcinoma was diagnosed by fine-needle aspiration biopsy under ultrasonic bronchoscope (Figure 1).
Thoracic computed tomography (CT) showing a mass in the left upper lobe before taking apatinib (A), an obvious cavitation in the mass (B), mass increasing after apatinib suspension for 6 days (C), cavitation extending gradually with added dose of apatinib via monthly CT examination (D and E), and an overall increase of mass despite the larger cavitation (F). The red arrows indicate specific region of tumor.
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Chest CT showed that the solid mass in the left upper lobe was slightly enlarged on February 26, 2016 (Figure 2A). CT on April 25, 2016, showed cavitation formed in the solid mass of the left lobe, and the solid mass was significantly reduced with stable mediastinal lymph node (Figure 2B). Cranial MRI on April 27, 2016, showed edema in the left occipital lobe alleviated (Figure 3B). Monthly imageological examination revealed the effectiveness of the combination treatment (Figures 2C-F and 3C-E).
Cranial MRI showing the encephaledem in the occipital lobe of the head (A), encephaledem obviously alleviating (B), slightly worsening after suspension of apatinib for 6 days (C), the encephaledem basically under control as shown by CT every 2 months (D and E).. Abbreviations: MRI, magnetic resonance imaging; CT, computed tomography.
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A bone scan suggested bone metastases and the encephaledem slightly deteriorated (Figure 3A), a possible indication of progressive disease (PD) and erlotinib resistance. MRI on April 27, 2016, showed edema in the left occipital lobe alleviated (Figure 3B). Monthly imageological examination revealed the effectiveness of the combination treatment (Figures 2C-F and 3C-E).
The venous blood routine from anticoagulant therapy.
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On August 25, the patient was hospitalized and treated with hemostasis and plasma supplement as the blood routine (Figure 4), and activated partial thromboplastin time (Figure 5) was monitored, stopping taking dabigatran.
The activated partial thromboplastin time from anticoagulant therapy.
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On August 25, the patient was hospitalized and treated with hemostasis and plasma supplement as the blood routine (Figure 4), and activated partial thromboplastin time (Figure 5) was monitored, stopping taking dabigatran.
The subcutaneous hemorrhage in limbs on August 31, 2016.
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Ultrasonography presented no thrombus despite recurred swelling in the left upper limb (Figure 6) until his death.