PMC8336986_01
(A) Preoperative chest CT scan (captured on March 19th, 2018). (B) Histology revealed squamous carcinoma of the lung (x100). (C) Postoperative chest CT follow-up (captured on April 11th, 2018). (D) PET-CT scan (captured on July 18th, 2019). (E) Histology findings indicated SCLC. (F) PET-CT scan (captured on September 11th, 2019). Significant abnormal findings were noted (arrow).
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Chinese Medicine on March 2018 for further examination with a chronic cough. Chest CT scan identified a 3x3-cm space-occupying lesion (Figure 1A). April 2nd, 2018, with histological analysis showing a left lung squamous carcinoma involving elastic fibers with the size of 3x3x2cm (Figure 1B), and the lymph nodes were negative. A post-operative CT scan is shown in Figure 1C. A PET-CT scan suggested a lesion of elevated uptake of FDG (SUV=9.5), 1.8x0.8cm (Figure 1D). Electronic bronchoscopy showed neoplasms in the left main bronchus, and histological analysis was SCLC (Figure 1E), with IHC positive for Syn and CGA and negative for Napsin A, TTF-1 (-), and P63 (-), with a Ki-67 index >50%. First-line treatment consisted of concurrent chemoradiotherapy (CCRT) (DT 60Gy/29 fractions) with etoposide/cisplatin with a good response (Figure 1F).
(A) Hepatic metastatic lesion and (B) bone metastases on PET-CT (captured on Nov. 11th, 2019). (C and D) Confirmation of CR after second line nivolumab and paclitaxel (captured on April 8th, 2020). (E) Cystoscopy showed that the entire bladder mucosa was edematous. (F) Histology of urothelium. Significant abnormal findings were noted (arrow).
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A further PET-CT confirmed a complete response using second-line nivolumab and paclitaxel (Figure 2C and D). Cystoscopy showed that the entire bladder mucosa was edematous and red but there was no evidence of cancer (Figure 2E). Histologic analysis revealed no evidence of malignancy (Figure 2F) but infiltrates of CD3- and CD8-positive lymphocytes into the urothelium were present (Figure 4 and Table 2).
Radiotherapy planning to be delivered to bone metastases for this patient.
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Bone radiotherapy of 30Gy/10f was also given (Figure 3).
IHC staining for the patient's tissue samples. (A-E) Lung squamous carcinoma staining for CD3, CD4, CD8, PD-1 and PD-L1, respectively. (F-J) Small cell lung cancer biopsy sample staining for CD3, CD4, CD8, PD-1 and PD-L1, respectively. (K-O) Urothelium biopsy staining for CD3, CD4, CD8, PD-1 and PD-L1, respectively.
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Histologic analysis revealed no evidence of malignancy (Figure 2F) but infiltrates of CD3- and CD8-positive lymphocytes into the urothelium were present (Figure 4 and Table 2).
Clinical course of the patient. *means "times" (for 6 weeks).
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The clinical course of this patient is summarized in Figure 5.