PMC9742587_01
Treatment timeline with representative clinical evaluation and radiologic images. Based on the pathological analysis of the right lung biopsy, together with results from CT scans of the chest, abdomen and radionuclide bone, the patient was diagnosed with a clinical stage IVb LADC, T1cN2M1c according to the eighth edition of The American Joint Committee on Cancer (AJCC) TNM classification.(A) Computed tomography (CT) scans showed the primary tumor mass (biopsy site, arrows) in the right lung at the time of diagnosis; (B, C) Chest CT showing stable disease (SD) following gefinitib treatment; (D) Chest CT showing stable disease in the primary lung site at disease progression. (E, F) Magnetic resonance imaging (MRI) showing the potential metastatic site (arrows) in leptomeninges. SD, stable disease; PD, progressive disease; NGS, next-generation sequencing. CSF, cerebrospinal fluid.
fonc-12-944963-g001.jpg
PMC9742587_01_fonc-12-944963-g001.jpg
f1
A 55-year-old female never-smoker was admitted to the hospital in August 2019 with a pulmonary mass detected by chest computed tomography (CT) during physical examination ( Figure 1A ). While no heterotypic cells were detected in the CSF, the same EGFR 19Del mutation was detected in the CSF ctDNA ( Figure 1 ). In May 2020, while the primary lung tumor remained stable ( Figure 1D ), brain MRIs showed an abnormal linear signal shadow of the leptomeninges, and clinical evidence of severe headache, vomiting, and aggravated restlessness in the limbs, suggesting the possibility of LM ( Figure 1E, F ).