PMC8091866_01
H&E staining of triple primary tumors and metastatic bone tumors of the case. (A and B) Primary lung SQCC (40x, 100x); (C and D) Immunohistochemistry staining of p63 and TTF1 for SQCC; (E and F) Primary CCRCC (40x, 100x); (G and H) Metastatic bone tumor (40x, 100x); (I and J) Primary prostate adenocarcinoma.
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A diagnosis of poor-differentiated SQCC (T1NxM0) was subsequently made by flexible bioptic fiberoptic bronchoscopy and immunohistochemistry staining of SQCC biomarkers (Figure 1A-D). His medical history had many significant aspects, including: 1) a previous diagnosis of primary clear cell renal cell carcinoma (CCRCC), grade 2, of the right kidney in June 2008 (Figure 1E and F). A partial rib resection was performed on the 11th right rib and pathology observed the presence of clear cells (Figure 1G and H). The patient started to take oral Sorafenib and Zoledronate since June 2013. 3) A previous diagnosis of primary prostate adenocarcinoma in January 2014, accidentally identified by prostate specific-antigen (PSA) check-up and needle biopsy (Table S1 and Figure 1I and J).
CT images reflect the dynamic changes of the patient's responses to the treatment plans. (A) Size of lung SQCC (1.7x1.7 cm, red dotted line) soon after the initial diagnosis by fiberoptic bronchoscopy; (B) Radiation pneumonitis and unchanged tumor size (1.7x1.7 cm, red dotted line) after radiotherapy; C) Radiation pneumonitis and increased tumor size (2.1x2.8 cm, red dotted line) after radiotherapy; (D) Increased tumor size (3.1x9.4 cm, red dotted line) after platinum-based chemotherapy; (E) Reduced tumor size (3.5x6.3 cm, red dotted line) 4 months after targeted therapy; (F) Further reduced tumor size (2.47x2.47 cm, red dotted line) 9 months after targeted therapy; (G and H) Follow-up images of CCRC and prostate adenocarcinoma in 2015 showed no sign of tumor recurrence.
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The patient's lung SQCC (Figure 2A) was inoperable since a left pneumonectomy was not possible. Tachypnea and dyspnea were soon reported and CT suggested radiation pneumonitis with increased tumor size (Figure 2B and C). November 2014. Next, the patient was treated with platinum-based chemotherapy (etoposide 120 mg/m2, IVGTT plus cisplatin 75 mg/m2, IVGTT or carboplatin 200 mg/m2, IGVTT, q21d/c) for five cycles from November 2014 to March 2015, but the tumor size was found to be significantly increased in February 2015 (Figure 2D and E), after which chemotherapy was maintained for one more cycle and soon abandoned in March 2015. At revisits after 4 months and 9 months in June and December 2015, chest CT showed a shrinkage of lung tumor size by 40% and 80% (Figure 2E and F), indicating that the targeted therapy had a remarkable therapeutical effect on the lung SQCC with continuous partial-response (PR). Meanwhile, no sign of visceral metastasis was found by abdominal CT scan (Figure 2G and H), suggesting that CCRCC and prostate adenocarcinoma were under effective control. However, the patient developed gradual collapse of the left lung (Figure 2C-F) due to occlusion on the hilum, respiratory function deterioration, and eventually died of a complication of pulmonary infection and cardiopulmonary failure in March 2016.