PMC9684319_01
Immunohistochemistry showed that PD-L1 expression in the tumor tissue was 5% for TPS and 10 for CPS (A-D). TPS, tumor proportion score; CPS, combined positive score.
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The results showed that BRCA1(-), PD-L1 TPS=5%, CPS=10, TMB 3.91Muts/Mb medium (lower than 67% of ovarian cancer patients), and microsatellite stable ( Figure 1 ).
1 CT follow-up images of the patient before and after cryoablation. (A-D) Before cryoablation of the patient, multiple masses and nodules of variable size were seen in the left upper lobe and lower lobe of both lungs. (E-H) Six months after cryoablation of the more significant lesion in the left upper lobe, the frozen area was seen to be smaller and firmer; the remaining multiple lung lesions had largely disappeared. (I-L) Nine months after cryoablation, only scarring was seen in the cryoablation area, and no lesions were seen in both lungs.
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The larger one was about 33 mm in diameter, and all were considered to be metastases in combination with medical history ( Figures 2A-D ). In addition, a small amount of fluid in bilateral chest cavities had been wholly absorbed ( Figures 2E-H ). At the subsequent three-month follow-up, we found that the residual scar in the area of cryoablation in the upper lobe of the left lung had further shrunk, the entire lung was free of any new or enlarged lesions than before, and the residual cords in the original larger tumor area in the lower lobe of the right lung had disappeared entirely ( Figures 2I-L ).
After CT-guided percutaneous biopsy, the patient developed pneumothorax and decreased oxygen saturation, which was treated with CT-guided tube drainage. (A) A left upper lobe mass with significant enhancement. (B) The needle slot of the 18G semi-automatic puncture needle was located in the center of the tumor. (C) No significant postoperative bleeding or pneumothorax was observed. (D) Pneumothorax was caused by the harsh coughing of the patient. (E) The patient was treated with a chest tube for drainage. (F) The pneumothorax had utterly disappeared after 1 week.
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To determine the pathological type of the multiple pulmonary tumors to guide the following treatment, we first selected the larger lesion in the left upper lobe of the lung for CT-guided percutaneous puncture biopsy after the routine preoperative examination upon admission ( Figure 3A ). Three strips of tumor tissue were obtained and sent for testing after puncture with a BD 18G co-axial biopsy needle (Bard Peripheral Vascular Inc, USA) ( Figure 3B ). After a minimally invasive biopsy, the patient did not experience significant bleeding or pneumothorax on the immediate postoperative CT scan ( Figure 3C ). CT scan showed a left-sided pneumothorax was developed, closed chest drainage was given, and the tube would be removed after the gas was drained ( Figures 3D-F ).
Cryoablation of a larger lesion in the upper lobe of the left lung. (A, B) Two probes were placed in different tumor parts, and cryoablation was performed on the tumor. The mediastinal window visualized the tumor filled with a low-density ice ball. (C, D) The lung window showed a ring-like increase in lung tissue density around the tumor. (E, F) After the cryoablation was completed, the cryo-probes were removed, and residual needle tracts were visible.
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CT scan was performed, the skin was marked with the puncture site with a routinely regional disinfected and sterile towel laid, 1% lidocaine was used for local anesthesia, and two 17G cryoprobes were percutaneously punctured into the left upper lobe of the lung under the CT-guidance, two freeze-ablation cycles were performed ( Figures 4A-D ). CT scans were performed at 5-minute intervals during the treatment to determine the ice ball's location and extent. No abnormality was found in the postoperative CT scan ( Figures 4E, F ).