PMC8058789_01
Radiological evaluation of the patient. (a) Computed tomography scan of the chest before treatment with pembrolizumab and radiation showing the primary lung cancer in the right upper lobe. (b) and (c) Significant regression of the lung tumor and mediastinal adenopathy after three cycles of pembrolizumab and continuing response in the lung tumor 4 months after stopping pembrolizumab. (d) Computed tomography scan of the abdomen prior to treatment with pembrolizumab. (e) and (f) After three cycles of pembrolizumab demonstrating regression of the tumor in the tail of the pancreas and continuing response in the pancreatic tumor 4 months after stopping pembrolizumab.
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Computed tomography (CT) scan revealed a right lung mass with mediastinal adenopathy (Figure 1). There was also a 7.4 cm mass in the tail of the pancreas (Figure 1). A CT scan revealed a marked reduction in the lesions in the chest and pancreas (Figure 1). Four months after stopping the pembrolizumab, the tumors in the chest and pancreas continued to regress (Figure 1).
Histologic and immunohistologic findings. (a) Hematoxylin and eosin stained lung fine needle aspiration cell block preparations composed of cohesive groups of malignant epithelioid cells diagnostic of adenocarcinoma. (b) Core biopsy of the pancreatic mass showing a higher grade pleomorphic tumor composed of more discohesive malignant epithelioid cells with massively enlarged eccentric nucleic, coarse chromatin and large prominent nucleoli. TTF-1 strongly positive staining of lung (c) and weakly positive of the pancreas (d); Napsin A positive staining of the lung (e) and no staining of the pancreas (f); CK7 positive staining of the lung (g) and no staining of the pancreas (h).
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IHC showed positivity for thyroid transcription factor-1 (TTF-1), cytokeratin 7 (CK7) and Napsin A, confirming its primary pulmonary origin (Figure 2). A core biopsy of the large mass in the tail of the pancreas revealed a different cytomorphology and immunoprofile from the lung biopsy (Figure 2).