PMC7379871_01
Tumor lesions detected at various times. PET-CT showing a mass in the middle lobe of the right lung (A). Tumor lesions in the brain before and after EP therapy (B). New masses in the brain after EP therapy (C).
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F2
Whole-body positron emission tomography computed tomography (PET-CT) identified areas of abnormal metabolism in the right lung, right hilum, and subcarinal lymph nodes (Figure 2A), as well as the left occipital lobe of the brain. MRI showed the metastatic tumor in the left occipital lobe dramatically increasing to 4.8 x 3.8 cm (Figure 2B). Meanwhile, four new masses were found in brain. After four cycles of EP treatment, new metastatic lesions were detected in the right brain (Figure 2C).
The imageological and cytological examinations of tumor metastases. Tumor metastases in the liver (A), left adrenal (A), and spinal cord (B) before irinotecan plus osimertinib, and enlarged metastatic lesions in the liver (A) and left adrenal (A) after treatment. (C) The HE and IHC staining of biopsy specimens in the case. Typical for SCLC, IHC was strongly positive for TTF1, Syn, CD56, and CgA.
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F3
After WBRT, the patient displayed symptomatic disease progression with multiple new liver, left adrenal gland, and spinal cord metastases (Figure 3A,B). TTF-1, CgA, and synaptophysin (Figure 3C). The tissue re-biopsy samples and blood samples were subjected to next-generation sequencing. However, the tumor dramatically progressed with enlargement of liver metastases (Figure 3A).