PMC9515488_01
PET/CT scan image before treatment. (A) PET/CT scan image of chest and abdomen; (B) PET/CT scan image of irregular soft tissue mass in the right hilum; (C) PET/CT scan image of the enlarged lymph node in right hilar; (D) PET/CT scan image of the enlarged lymph node in left hilar.
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The PET-CT showed a size of 7.7 cm x 6.8 cm x 5.7 cm irregular soft tissue mass in the right hilum, standardized uptake value (SUV) max: 14.0; enlarged lymph node in the right hilar with a size of 1.6 cm x 1.2 cm, SUVmax 3.6; enlarged lymph node in the left hilar with a size of 1.9 cm x 1.3 cm, SUVmax 9.2; which indicated that the patient suffered from right lung cancer with bilateral hilar lymph node metastasis ( Figure 1 ).
Histopathological and immunohistochemical examinations of primary tumor focus in the right lung before operation (100x) (A) HE-stained image of primary tumor focus; (B) p40 (+); (C) ALK (-); (D) PD-L1 (+).
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Immunohistochemistry: CK5/6 (+), p63 (+), P40 (+), p53 (-, mutant), Ki67 (+), approximately 50%, CK7 (-), TTF-1 (-), CD56 (-), ALK (-), programmed cell death ligand 1 (PD-L1) expression was positive, tumor Proportion Score: 83% ( Figure 2 ).
Chest CT scans before and after two cycles of anti-PD-1 immunotherapy combined with anti-angiogenesis therapy and chemotherapy (A, B) Chest CT scans of primary tumor focus in the right lung before and after two cycles of anti-PD-1 immunotherapy combined with anti-angiogenesis therapy and chemotherapy respectively; (C, D) Chest CT scans of the metastatic lymph node in left hilar before and after two cycles of anti-PD-1 immunotherapy combined with anti-angiogenesis therapy and chemotherapy respectively.
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The efficacy was evaluated as partial response (PR), and the clinical stage was redivided into IIA (crT1cN1M0) according to the chest and abdomen enhancement CT image, which opened up the opportunity for surgical treatment ( Figure 3 ).
Surgical tissue specimen and postoperative histopathological HE-stained picture of the tumor tissue (A) Surgical tissue specimen; (B) HE-stained image of resected tumor tissue (100x).
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Additionally, no cancer metastasis was found in the parabronchial lymph nodes (0/1), which indicated that this patient had successfully transformed from unresectable stage IIIC lung cancer to radical surgery (ypT0N0M0) ( Figure 4 ).
Diagnosis and treatment information of this patient.
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The related diagnosis and treatment information of this patient are shown in  Figure 5 .