PMC9881487_01
Chest CT (a) in October 2019, before chemo-radiation, (b) in January 2022, 1 year after durvalumab and (c, d) in July 2022, 1.5 years after durvalumab. The white (a-c) or black (d) arrows indicate the shadow of the primary tumor (a, b) or sarcoid-like granulomatosis (c, d) in the right lower lobe. CT: computed tomography.
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F1
A 56-year-old Japanese woman was referred to our department of respiratory medicine for intermittent bloody sputum and a tumor shadow in the right lower lobe in chest X-ray and computed tomography (CT) scan (Fig. 1a). Thereafter, comparison of follow-up CTs of 1 and 1.5 years after durvalumab showed growth of the tumor in the right S6, which had lost intra-tumorous air bronchogram (Fig. 1b-d). Neither CT nor FDG-PET found mediastinal and distant metastases (Fig. 1c-d, 3).
Bronchoscopic sample in October 2019 at the diagnosis. (a) Hematoxylin and eosin and (b) PD-L1 (22C3 pharmDx assay) stains. PD-L1: PD-1 ligand; PD-1: programmed cell death protein 1.
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F2
She was diagnosed of squamous cell carcinoma by transbronchial biopsy (Fig. 2a). Tumor proportion score (TPS) of PD-L1 was low expression (TPS 30-40%) (22C3 pharmDx assay) (Fig. 2b).
Fused image of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in July 2022 before the right lower lobe lobectomy. The white arrow indicates the sarcoid-like granulomatosis lesion. FDG-PET: fluorodeoxyglucose positron emission tomography; CT: computed tomography.
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F3
PET-CT also revealed abnormal uptake in the tumor in the right S6 (SUVmax, 4.7) (Fig. 3). Neither CT nor FDG-PET found mediastinal and distant metastases (Fig. 1c-d, 3).
Macroscopical (a) and histopathological (b, c) findings of the resected right lower lobe. (b, c) Victoria blue/hematoxylin and eosin stain (magnification; (b) x 4, (c) x 10).
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F4
The resected right lower lobe macroscopically contained a poorly-marginated and grayish white tumor (Fig. 4a). Histopathologically, the tumor contained widespread organized lesions with infiltration of inflammatory cells, diffuse epithelioid granuloma with partial necrotic lesions, and many multinucleated giant cells (Fig. 4b, c).
Immunohistochemistry of the resected right lower lobe, stained by anti-CD3 (a), CD4 (b), CD8 (c), CD20 (d) and CD79a (e) antibodies (magnification: x 4).
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F5
T cells predominantly infiltrated, but CD79alpha (+) B cells also appeared. There were few CD4 (+) T cells and a relatively small number of scattered CD20 (+) B cells (Fig. 5a-d).