PMC8173040_01
Imaging findings, pathological results and PD-L1 expressions of primary lung tumor (A) and right upper arm metastasis (B) in this LCLC case. Initial CT scan revealed a primary lung tumor in right lower lobe, and color ultrasound scan at 1 month after operation presented a right upper arm metastasis. Pathological results of both foci were confirmed LCLC with microscope magnification at 400x. Immumohistochemistry findings demonstrated PD-L1 expression with TPS 60-70% for the primary tumor and TPS 40-49% for right upper arm metastasis.
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Computer tomography (CT) ( Figure 1A ) revealed only a mass in the right pulmonary lower lobe and no bronchial or lymph node lesions. Unexpectedly, multiple fulminant body and mouth lesions was found in the right upper arm ( Figure 1B ), right elbow, right waist, and tongue root at 1 month after operation. Immumohistochemistry staining demonstrated PD-L1 expression with tumor proportion score (TPS) of 60-70% for the primary tumor in right lower lobe ( Figure 1A ) and 40-49% for the body metastasis in the right upper arm ( Figure 1B ) respectively.
Clinical outcomes of NSE level (A), mouth metastasis (B) and multiple organs (C) of this LCLC case. NSE level was detected before surgery or before each cycle treatment. After radical surgery, serum NSE level dramatically increased after surgery, and gradually decreased to normal levels after three cycle treatments of antiangiogenic-immunotherapy. In addition, mouth lesion appeared after surgery and disappeared after combination antiangiogenic-immunotherapy. Besides, there were no abnormity in multiple organs and PR lasted for more than 12 months.
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Then, serum NSE level gradually decreased to 16.63 ng/ml ( Figure 2A ) and mouth lesion ( Figure 2B ) disappeared for 3-cycle continuous treatment in October 2019. In addition, there were no abnormity in multiple organs ( Figure 2C ).