PMC6689559_01
(A) CT scan of the chest demonstrated a faint infiltrative shadow in the right lower lung field (red arrow). (B) Repeated CT scan showed inflammation of the right pulmonary was progressing nearly one month later. The right lung is scattered in the flaky blurred shadow with an unclear boundary, which is obvious in the middle and lower lobes (red arrow). (C and D) CT pulmonary angiography revealed extensive intraluminal filling defects in the trunk and branches of the right pulmonary artery (red arrow). No filling defects were observed in the left pulmonary artery.
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A computed tomography (CT) scan of the chest revealed a faint infiltrative shadow in the right lower lung field (Figure 1A). Although the D-dimer and blood gas analyses were normal, CT pulmonary angiography was performed (Figure 1C and D).
(A) Increased FDG uptake of PET/CT observed in an intraluminal lesion of the right pulmonary artery (red arrow in A , SUVmax 9.69). (B) Increased FDG uptake observed along the wall of the right lobar (red arrow in B, SUVmax 2.45).
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A right pleural nodule with increased FDG uptake (SUVmax =2.45) was next to the 7th rib on the right (Figure 2A and B).
Hematoxylin-eosin staining and immunohistochemistry staining in tumor cells.. Notes: (A and B) Hematoxylin-eosin staining (x100, and 400, respectively); (C and D) The tumor cells were positive for vimentin (x100, and 400, respectively); (E and F) The tumor cells were positive for desmin (x100, and 400, respectively); (G and H) The tumor cells were positive for MDM2 (x100, and 400, respectively); (I and J) The tumor cells were positive for P53 (x100, and 400, respectively).
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These tumors also overexpress MDM2 and mutant P53 (Figure 3).
(A and B) After a chemotherapy regimen of pemetrexed, CT scan showed metastasis lesions in the right upper lobe and right lower lobe of the patient. (C and D) CT scan showed metastasis lesions in the right upper lobe and right lower lobe of the patient after two cycles of anlotinib. The red arrows represent the metastasis lesions in the right lung.
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In addition, a CT scan showed that right lung metastasis lesions of the patient became larger with newly liver metastasis and thoracic vertebra metastasis. (Figure 4A and B) Given the efficacy of anlotinib in sarcoma, the patient received anlotinib with a cycle of at a dose of 12 mg/day for two weeks and then stopped for one week. More than one month later, right lung metastasis lesions were slightly smaller than before, and pulmonary artery pressure of 70 mmHg was lower (Figure 4C and D).