PMC6349695_01
Case 1 (A,B) Chest X-ray and computed tomography (CT) before nivolumab administration shows a lung mass from the right mediastinum to the right hilar region. (C,D) Chest X-ray and CT after 2 cycles of nivolumab administration shows tumor regression. (E) Chest X-ray after 4 cycles of nivolumab administration shows cardiomegaly. (F) Echocardiography shows massive pericardial effusion (*: effusion). (G,H) Chest X-ray and CT after pericardiocentesis followed by nivolumab administration shows improvement of cardiomegaly and further tumor regression.
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F1
His serum carcinoembryonic antigen (CEA) level before initiation of nivolumab therapy was 143.7 ng/ml; his chest X-ray and CT are presented as Figures 1A,B, respectively. After two cycles of nivolumab administration, the tumor size decreased (Figures 1C,D, respectively). A chest X-ray revealed cardiomegaly, and echocardiography indicated massive pericardial effusion (Figures 1E,F, respectively). After five cycles of nivolumab administration following the pericardiocentesis, the pericardial effusion did not recur (Figures 1G,H, respectively); however, intraperitoneal dissemination worsened again, and nivolumab therapy was discontinued.
PMC6349695_02
Case 2 (A-C) Chest X-ray and computed tomography (CT) before nivolumab administration. Primary lung cancer lesion (circle) and a small amount of pericardial effusion are detected. (D) Chest X-ray after nivolumab administration shows cardiomegaly. (E,F) Chest CT after nivolumab administration shows massive pericardial effusion and enlargement of the primary lesion (circle). (G) Chest X-ray 2 months after the second pericardiocentesis shows no cardiomegaly. (H-J) Chest CT 2 months after the second pericardiocentesis shows a decrease in pericardial effusion, reduction of the primary lesion (circle), and a few new intrapulmonary lesions (arrows).
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F2
The chest X-ray and CT before initiation of nivolumab therapy are presented as Figures 2A-C, respectively, (circle: primary lesion), and the serum cytokeratin 19-fragment (CYFRA 21-1) level was 20.7 ng/ml. A chest X-ray revealed cardiomegaly (Figure 2D). Massive pericardial effusion was detected by echocardiography as well as by chest CT (Figure 2E). In addition, the chest CT detected enlargement of the primary lesion (Figure 2F, circle). Two months after the second pericardiocentesis, a chest X-ray showed no cardiomegaly (Figure 2G), and chest CT showed decreasing pericardial effusion (Figure 2H). Despite the fact that the primary lesion was reduced (Figure 2I, circle), a few new intrapulmonary lesions appeared (Figure 2J, arrows); therefore, the disease was deemed to be progressing.