PMC9911301_01
PET scan at baseline showing the progression at mediastinal lymph nodes.
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Based on tumor's molecular characteristics, therapy with pembrolizumab was started with a partial response lasting for 28 months, when tumor progressed on mediastinal lymph nodes ( Figure 1 ).
(A) Computed tomography scan showing multiple bone lesions. (B) Bone scan showing no evidence of bone metastases.
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The computed tomography (CT) scan performed 2 months following the beginning of therapy showed a partial response on lymph nodes with the appearance of multiple bone lesions, as reported in  Figure 2A , not revealed by the bone scan ( Figure 2B ).
(A) Hematoxylin and eosin staining of adenocarcinoma of the lung, TTF1+ associated with fibrosis (70%); (B) Giemsa eosinophilic infiltrate, as indicated by the arrows.
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At BMB, a much prominent metastasis of adenocarcinoma (with the same histopathological and immunophenotypical features), embedded within prominent fibrosis (70% of biopsy volume) and eosinophils ( Figures 3A, B ) was disclosed.
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Timeline showing the clinical history of both patients.
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Since July 2021, he developed hypereosinophilia (up to 8 x 109/L), as shown in  Figure 4 .