PMC7528199_01
Brain MRI three-dimensional fast spoiled gradient-echo images. (A) Single tumor with extensive edema around 19 x 25 x 21 mm in size was found in the left parietal lobe on admission. (B) Brain edema worsened after CyberKnife treatment. (C) Brain edema markedly improved after removal of the brain tumor. (D) Macroscopic specimen of the resected tumor showed a yellowish-white tumor of 20 x 15 x 10 mm in size and with a necrotic tendency. (E) A proliferation of atypical spindle cells, multinucleated cells, and multinucleated giant cells with eosinophilic cytoplasm was observed on hematoxylin and eosin staining. (F) Immunostaining with cytokeratin AE1/AE3 was extensively positive, suggesting an epithelial tumor. (G) Anti-p40 antibody was positive, suggesting lung squamous cell carcinoma.
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Brain MRI showed a single tumor with extensive edema around 19 x 25 x 21 mm in size in the left parietal lobe, and chest CT showed a 38-mm tumor adjacent to the sutures of the previous lobectomy in the lower lobe of the left lung (Fig. 1, Fig. 2A). However, hemiplegia and aphasia gradually worsened a few days later, and repeat brain MRI showed further exacerbation of edema (Fig. 1-B). Postoperatively, rehabilitation was resumed, corticosteroid therapy ended on day 54 due to improvement of the edema on brain MRI (Fig. 1-C), and only LEV was continued to prevent seizures.
Chest CT images. (A) A 38-mm tumor was found in the left lower lobe of the lung, and no specific lesion was found in the background lung. (B) Multiple GGOs were found in both lung fields with small bilateral pleural effusion. (C) GGOs disappeared after LEV discontinuation and corticosteroid treatment.
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Chest CT showed GGO in both lung fields and a small amount of pleural effusion (Fig. 2-B). Withdrawal of LEV and administration of methylprednisolone pulse therapy and prednisolone for 10 days improved her respiratory failure and chest CT findings (Fig. 2-C).
PMC7528199_02
Chest CT images. (A) A 38-mm tumor was found in the left lower lobe of the lung, and no specific lesion was found in the background lung. (B) Multiple GGOs were found in both lung fields with small bilateral pleural effusion. (C) GGOs disappeared after LEV discontinuation and corticosteroid treatment.
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Chest CT showed GGO in both lung fields and a small amount of pleural effusion (Fig. 2-B). Withdrawal of LEV and administration of methylprednisolone pulse therapy and prednisolone for 10 days improved her respiratory failure and chest CT findings (Fig. 2-C).
Changes over time in the C-reactive protein (CRP) level and the pulmonary lesion on chest X-ray. The patient underwent CyberKnife treatment on day 12 with glycerol and dexamethasone. However, improvement of neurological symptoms was not obtained, and tumor removal was performed on day 31 with the addition of LEV administration. She developed pneumonia on day 57 after she began to receive LEV only from day 55, and it worsened without responding to antibiotics. Drug-induced pneumonia was diagnosed with bronchoscopy, and systemic corticosteroid administration rapidly improved pneumonia. DEX, dexamethasone; PSL, prednisolone; mPSL, methylprednisolone; SBT/ABPC, sulbactam/ampicillin; TAZ/PIPC, tazobactam/piperacillin; AZM, azithromycin.
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On day 57, fever, dyspnea, and cough appeared, and a chest X-ray showed ground-glass opacities (GGO) in the left middle, left lower, and right lower lung fields (Fig. 3).