PMC7481563_01
18FDG-PET CT. The abnormal accumulation of FDG was detected in a mass in the left upper lobe (A), subaortic lymph nodes (B), second lumbar vertebra (C), and left pleural fluid (D) with high metabolic activity (SUVmax: 1.55-9.80).
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A18F-fluorodeoxyglucose positron-emission tomography (FDG-PET)/computed tomography (CT) showed the accumulation of FDG in this mass, subaortic lymph nodes, left pleural effusion and second lumbar vertebra (Fig. 1).
MRI and pathological findings of the liver. MRI showed no intrahepatic bile duct dilatation, but biliary wall irregularity and discontinuous narrowing of the bile duct were noted (A,B). A liver biopsy showed chronic inflammatory cell infiltrate and juvenile epithelial bile duct around the slightly enlarged portal vein area (C).
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MRCP showed no dilation of the intrahepatic bile ducts but did show irregular walls and discontinuous narrowing, and a high signal around the portal vein was detected on T2-weighted imaging (Fig. 2A, B). On the lobules, binuclear cells, mild sinusoid dilatation, very mild large drop statues, and necrotic inflammatory reaction of necrotic small cells, including neutrophils, were observed (Fig. 2C).
Pathological findings of the repeated liver biopsy specimen after steroid pulse therapy. Chronic inflammatory cells slightly were observed around the portal vein area but showed an improving trend (D).
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Her liver injury improved, and a repeated liver biopsy confirmed the pathological improvement of cholangitis six months after the onset of this condition (Fig. 3), which enabled gradual corticosteroid reduction and immunosuppressant discontinuation.
Chest CT findings before the treatment (A) and one year after the discontinuation of pembrolizumab.
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In addition, her lung cancer has not relapsed in the one year since the discontinuation of pembrolizumab (Fig. 4).