PMC10199203_01
Computed tomography on admission shows multiple cavitary lung lesions and wall thickening in the sigmoid region of the rectum. Representative cavitary lesions in the (A) S3 region of the left lung, (B) S3, and (C) S6 region of the right lung (black arrowheads). (D) Wall thickening in the rectum (white arrowhead).
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C-reactive protein level: 2.90 mg/dL, white blood cell count: 10700/muL, carcinoembryonic antigen: 5.9 ng/mL, and carbohydrate antigen 19-9: 154.0 pg/mL (Table 1). Computed tomography (CT) showed multiple cavitary lesions with consolidation in the S3 region of the left lung and the S1, S2, S4, S6, and S10 regions of the right lung (Fig. 1A-C) and wall thickening in the sigmoid region of the rectum (Fig. 1D).
The tumor found in the rectum is colorectal cancer. Tumor detected by lower gastrointestinal endoscopy. (B) Hematoxylin and eosin stain (H&E) staining of the tumor, x 200.
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A tumor was found in the rectum (Fig. 2A), and histopathology revealed well/moderately-differentiated tubular adenocarcinoma (Fig. 2B).
Multiple cavitary lung lesions remained after antibiotic treatment. Representative persistent cavitary lung lesions (black arrowheads).
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CT was performed on the 10th day after admission. Consolidation decreased, but multiple cavitary lung lesions persisted (Fig. 3).
The cavitary lung lesion in the S6 region is a lung metastasis from colorectal cancer. Histopathology or immunostaining showing (A) hematoxylin and eosin staining (H&E), x 200, (B) cytokeratin 7 (CK7), x 200, (C) cytokeratin 20 (CK20), x 200, (D) thyroid transcription factor-1 (TTF-1), x 200, (E) caudal-related homeobox transcription factor 2 (CDX2), x 200.
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Histopathology revealed well-differentiated adenocarcinoma (Fig. 4A), and immunostaining showed cytokeratin (CK) 7-/CK20+/thyroid transcription factor 1 (TTF-1) -/caudal-related homeobox transcription factor 2 (CDX2) + (Fig. 4B-E).
Multiple lung cavitary lesions shrank after chemotherapy. Representative reduced cavitary lung lesions (black arrowheads).
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The follow-up CT after three cycles of chemotherapy showed that all multiple cavitary lung lesions had decreased (Fig. 5).