PMC5944445_01
Prior to neoadjuvant chemotherapy, computerized tomography images of chest in March 2015 indicated a quasi-circular mass in the left lower pulmonary lobe, together with an enlarged mediastinal lymph node.
ott-11-2557Fig1.jpg
PMC5944445_01_ott-11-2557Fig1.jpg
f1-ott-11-2557
Chest computerized tomography (CT) (Figure 1) showed a quasi-circular mass (25.1 x 22.2 mm) in the left lower pulmonary lobe, together with an enlarged mediastinal lymph node (7.7 mm).
Histopathological examination of the biopsy specimen revealed a poorly differentiated adenocarcinoma with neuroendocrine differentiation (A, x100), immunohistochemical staining for CK (B, x200), CK7 (C, x200), Ki-67 (D, x200), P63 (E, x200), and transcription factor-1 (F, x200).. Abbreviation: CK, cytokeratin.
ott-11-2557Fig2.jpg
PMC5944445_01_ott-11-2557Fig2.jpg
f2-ott-11-2557
Pathological analysis revealed a poorly differentiated adenocarcinoma with neuroendocrine differentiation (Figure 2A). Immunohistochemistry showed positive staining of cytokeratin (CK), with CK7 and Ki-67 index of 60%, but negative staining of P63 and thyroid transcription factor-1 (Figure 2B-F).
After two cycles of pemetrexed with cisplatin neoadjuvant chemotherapy, computerized tomography images of chest in May 2015 indicated that the left lower lobe tumor shrank significantly than before and the enlarged mediastinal lymph node almost disappeared.
ott-11-2557Fig3.jpg
PMC5944445_01_ott-11-2557Fig3.jpg
f3-ott-11-2557
Chest CT scan in May 2015 showed that the left lower lobe tumor had significantly reduced to 12.7 x 7.4 mm in size, and the enlarged mediastinal lymph node almost disappeared (Figure 3).
Histopathological examination of surgical specimens revealed LCNEC.. Notes: H&E staining for specimens (A, x200) and immunohistochemical staining for CD56 (B, x200), synaptophysin (C, x200), chromogranin-A (D, x200), neuron-specific enolase (E, x200), and NapsinA (F, x200).. Abbreviations: CD56, cluster of differentiation 56; LCNEC, large-cell neuroendocrine carcinoma.
ott-11-2557Fig4.jpg
PMC5944445_01_ott-11-2557Fig4.jpg
f4-ott-11-2557
Immunohistochemical analysis (Figure 4) demonstrated intense immunoreactivity of CK, CK7, as well as NSE, chromogranin-A (CgA), and cluster of differentiation 56 (CD56), which was a typical LCNEC component.
Computerized tomography images of chest indicated that no evidence of recurrence has been detected during the 24-month follow-up. (A and B) Images in June 2015; (C and D) Images in March 2017. (A and C) Images of vertical window; (B and D): images of lung window.
ott-11-2557Fig5.jpg
PMC5944445_01_ott-11-2557Fig5.jpg
f5-ott-11-2557
Chest CT scan 1 month after surgical resection revealed no tumor recurrence (Figure 5A and B). No evidence of recurrence has been detected during the 24-month follow-up after surgery (Figure 5C and D).