PMC8131857_01
Computed tomography (CT) of the chest. (A) shows no positive finding in the initial imaging of both lungs on August 1, 2019. (B) shows scattered high-density nodular shadows of different sizes in both lungs (January 10, 2020). (C-E) Re-examination CT on February 17, 2020 (after antibiotics are administered); February 24 (after regular doses of hormone therapy); and February 27 (after hormone shock therapy). In both lungs, the lesions gradually progressed, demonstrating multiple scattered cotton-like, lump-like high-density shadows, and pleural effusion. (F) Re-examination CT after treatment with Anlotinib and Pembrolizumab for 2 weeks (March 19, 2020). The pleural effusion is decreased, and pulmonary lesions are partially resolved.
fonc-11-629597-g001.jpg
PMC8131857_01_fonc-11-629597-g001.jpg
f1
Chest computed tomography (CT) scan was performed using a 64-slice spiral CT (Brilliance 64, Philips Healthcare, The Netherlands) on Aug 1, 2019 ( Figure 1A ). Cough medications were ineffective. Some of the nodules were surrounded by ground-glass shadow ( Figure 1B ). 18F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (18FDG-PET/CT) showed that multiple solid nodules of different sizes were diffused in both lungs, with a maximum standardized uptake values (SUV) of 4.29 ( Figure 2 ). The CT was used for the patient follow-up, and the imaging revealed worse findings than the previous one, on February 17, 2020 ( Figure 1C ). Re-examination by CT scan showed that there was an obvious halo sign around the focus, which indicated a lesion combined with bleeding ( Figure 1D ) and pulmonary auscultation showed bilateral rales. Owing to the deterioration in symptoms and CT imaging ( Figure 1E ), experts of the above departments from Peking Union Medical College Hospital also participated in the multidisciplinary discuss of the patient online. After 2 weeks of treatment, the pulmonary lesions showed that pleural effusion decreased, and pulmonary lesions partially resolved ( Figure 1F ).
Positron emission tomography-computed tomography (PET/CT) of the chest demonstrates that multiple solid nodules of different sizes are diffused in both lungs, showing increased metabolic activity with a maximum SUV value of 4.29.
fonc-11-629597-g002.jpg
PMC8131857_01_fonc-11-629597-g002.jpg
f2
Some of the nodules were surrounded by ground-glass shadow ( Figure 1B ). 18F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (18FDG-PET/CT) showed that multiple solid nodules of different sizes were diffused in both lungs, with a maximum standardized uptake values (SUV) of 4.29 ( Figure 2 ).
Magnetic resonance imaging (MRI) of a lesion beside the left submandibular gland. The lesion demonstrates heterogeneous hyper-intensity on axial (A) and coronary (B) fat-suppressed T2-weighted images, as well as on axial diffusion-weighted images (C). Axial T1-weighted image (D) showing slight hypo-intensity.
fonc-11-629597-g003.jpg
PMC8131857_01_fonc-11-629597-g003.jpg
f3
Axial T1-weighted image showed slight hypo-intensity around the left submandibular gland ( Figure 3 ).
Histological examination and immunohistochemical analysis of the biopsy specimen beside the left submandibular gland. (A, B) The gland is composed of irregular dilated vascular lacunae, which are filled with red cells. Vascular channel-like structure with vague lumen formats by abnormal, pleomorphic, malignant endothelial cells, which can be rounded, polygonal, or fusiform and can have an epithelioid appearance. The arrows point to the red cells. Magnification of (A) is 100x, and (B) is 200x. (C) The expression of CD31 is determined using immunohistochemical staining (100x magnification). (D) The expression of CD34 is determined using immunohistochemical staining (100x magnification).
fonc-11-629597-g004.jpg
PMC8131857_01_fonc-11-629597-g004.jpg
f4
The histopathology of surgical tissue sections showed that it was a metastatic tumor, and immunohistochemical analysis revealed CD31 and CD34 expression ( Figure 4 ), which confirmed the diagnosis of metastatic angiosarcoma.