PMC9992534_01
Schematic of treatment history of Case 1. (A) The timeline of treatment. (B) Chest CT images throughout the disease course. (C) Pathological examination of the surgical specimen. IHC testing (400x) results showed positive expression of TTF-1, CK7 and Ki67.
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A 62-year-old man with 40 pack-year smoking history was admitted to our hospital due to right chest pain ( Figure 1A ). The computed tomography (CT) revealed a tumor in the right lung with multiple pulmonary metastases, right clavicle involvement and right neck lymph node metastasis on November 26, 2020 ( Figure 1B ). Bronchoscopic biopsy and Immunohistochemical (IHC) analysis revealed adenocarcinoma with positive expression of TTF-1, CK7 and Ki67 ( Figure 1C ). The treatment is still being continued, and the timeline of all treatment process for the patient is shown in  Figure 1 .
PMC9992534_02
Schematic of treatment history of Case 2. (A) The timeline of treatment. (B) Chest CT images and brain MRI throughout the disease course. (C) Pathological examination of the surgical specimen. IHC testing (400x) results showed positive expression of CK7, PD-L1 and Ki67.
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Chinese female non-smoker was presented to our hospital with no family history of cancer suffered from repeated coughing on Feb 25, 2021 ( Figure 2A ). CT of the chest revealed a density mass in the right lung and multiple metastases in the mediastinal lymph nodes, vertebral lumbalis and right adrenal ( Figure 2B ). TTF-1 and ALK, whereas focal staining was positive for CK7 and ki67 ( Figure 2C ). MET amplification (copy number 11.1) was detected ( Table 1 ). Magnetic resonance imaging (MRI) scans revealed brain metastases ( Figure 2B ) on April 20, 2022.
PMC9992534_03
Schematic of treatment history of Case 3. (A) The timeline of treatment. (B) Chest CT images throughout the disease course. (C) Pathological examination of the surgical specimen. IHC testing (400x) results showed positive expression of Napsin A and TTF-1.
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Chinese male with no history of smoking visited our hospital in August 2017 with the chief complaint of dyspnea and pain in chest ( Figure 3A ). CT revealed a massive shadow in the upper lobe of the left lung, as well as metastases in both lungs and mediastinal lymph nodes ( Figure 3B ). TTF-1(+), NapsinA (+), and ALK (-), Ki67 positive rate 40%, indicating lung adenocarcinoma ( Figure 3C ). Chest CT scan 1month later demonstrated obvious shrinkage (PR) and 8 months later it showed confirmed PR ( Figure 3A ).