PMC7506151_01
(A) Chest computed tomography (CT) pulmonary window on April 19, 2018 showed an irregular solid mass in the lower lobe of the left lung of about 4.0 x 1.9 cm in size. (B) Chest CT pulmonary window on July 25, 2018 showed the tumor in the lower lobe of the left lung with an irregular shape and uneven density at about 3.5 x 1.1 cm. (C) Chest CT pulmonary window on September 18, 2019 showed an irregular solid mass striated shadow in the lower lobe of the left lung at 2.1 x 0.4 cm in size.
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Chest CT on April 19, 2018 revealed an irregular solid mass in the lower lobe of the left lung, about 4.0 x 1.9 cm in size, considered as peripheral lung cancer (Figure 1A). On July 25, 2018, CT examination showed that the lower lobe of the left lung was irregular in shape and uneven in density with a size of about 3.50 x 1.1 cm (Figure 1B). Chest CT showed an irregular solid mass in the lower lobe of the left lung, about 2.1 x 0.4 cm in size (Figure 1C).
(A) Magnetic resonance imaging (MRI) T2 fluid-attenuated inversion recovery (FLAIR) enhanced scan on May 10, 2018 showed abnormally high signal shadows in the medulla oblongata, pons, and ventral and dorsolateral line of the midbrain, suggesting soft leptomeningeal metastasis. (B) MRI T2 FLAIR enhanced scan on July 31, 2018 showed medulla oblongata, pons, midbrain ventral, and dorsolateral line abnormally high signal shadows, with no significant changes compared with the MRI results on May 10, 2018. (C) MRI T2 FLAIR enhanced scan on September 18, 2019 showed medulla oblongata, pons, midbrain ventral, and dorsal lateral abnormally high signal shadows.
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On May 10, 2018, an enhanced MRI scan showed abnormal high-signal images of the medulla oblongata, pontine, ventral midbrain, and dorsal lateral lineaments, indicative of leptomeningeal metastasis (Figure 2A). Enhanced MRI scan on July 31, 2018 showed a high signal shadow of the medulla oblongata, pontine, ventral midbrain, and dorsal lateral lineation, with no significant changes compared with the previous one (Figure 2B). The abnormal signal showed no significant change compared with the previous one (Figure 2C).
The carcinoembryonic antigen (CEA) levels from the cerebrospinal fluid (CSF) and peripheral blood were significantly decreased.
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The CEA levels in the peripheral blood and CSF were 42.95 and 1,717.5 ng/ml, respectively (Figure 3).