PMC9905415_01
Computed tomography (CT) scan of the patient throughout the whole course of diagnosis and treatment. Figures A-E, imaging changes of chest CT (mediastinal window and pulmonary window) at different times.
fonc-13-1062138-g001.jpg
PMC9905415_01_fonc-13-1062138-g001.jpg
f1
CT scan identified an infectious lesion in the left lower lobe, accompanied by pulmonary atelectasis and an upper lobe nodule in the right lung ( Figure 1A ). CT indicated that the soft tissue mass and obstructive atelectasis in the left lower lobe were absorbed ( Figure 1B ). Considering bilateral lung metastases before treatment, he received adjuvant chemotherapy as an initial treatment. After four cycles of docetaxel plus nedaplatin (TP) regimen, CT showed a partial response in the left lower lobe; however, the right lung nodule showed no significant change ( Figure 1C ). CT showed a very good partial response in the left lower lobe, while the right lung nodular was larger than before ( Figure 1D ). Considering the significant regression of the left lung lesion, the patient commenced adenocarcinoma treatment. The right lung lesion had obviously diminished after completion of the first immunochemotherapy cycle ( Figure 1E ) and he achieved very good remission in both lungs after three cycles of this regimen ( Figure 1F ).
Squamous cell carcinoma. Hematoxylin and eosin staining showing squamous cell carcinoma histology (A). The immunohistochemical examination indicated malignant cells immunoreactive for P40 (B); positive for P63 (C); strongly positive for CK5/6 (D). Magnification 100x.
fonc-13-1062138-g002.jpg
PMC9905415_01_fonc-13-1062138-g002.jpg
f2
Hematoxylin and eosin (HE) staining showed squamous cell carcinoma ( Figure 2A ). CK5/6 positive status ( Figures 2B-D ). Considering a fungal infection in the left lower lobe and atelectasis, he first received anti-infection therapy for approximately 1 month.
Adenocarcinoma. Hematoxylin and eosin staining showing adenocarcinoma histology (A). The immunohistochemical examination indicated malignant cells immunoreactive for TTF-1 (B); weakly positive for NapsinA (C); strongly positive for CK7 (D). Magnification 100x.
fonc-13-1062138-g003.jpg
PMC9905415_01_fonc-13-1062138-g003.jpg
f3
Pathological examination showed changes which were completely different from the left lung ( Figure 3A ). IHC staining showed that CK7 and TTF-1 were strongly positive, while NapsinA was weakly positive ( Figures 3B-D ), therefore, the pathological diagnosis was adenocarcinoma.
The timeline of the patient's events from diagnosis to treatment. CT, computed tomography; FB, fiberoptic bronchoscopy; TP, docetaxel plus nedaplatin; SBRT, stereotactic body radiation therapy; ICI, immune checkpoint inhibitor; PP, pemetrexed plus carboplatin; PR, partial remission; IMRT, intensity-modulated radiation therapy.
fonc-13-1062138-g004.jpg
PMC9905415_01_fonc-13-1062138-g004.jpg
f4
Detailed diagnosis information and a treatment flow chart are shown ( Figure 4 ).