PMC3961127_01
Primary lung tumor and interstitial pneumonia prior to and following treatment. (A) Prior to chemotherapy, multiple nodules were scattered in the double-lung field. (B) Following four cycles of chemotherapy, the therapeutic effect was progressive disease; (C) 30 days subsequent to the last administration of gefitinib, the therapeutic effect was partial response; (D) 60 days subsequent to the last administration of gefitinib, interstitial pneumonia occurred. (E) Following seven days of treatment, interstitial pneumonia was significantly relieved. (F) Results following 30 days of treatment; (G) results following one year of gefitinib treatment. (H and I) Lung pathology following interstitial pneumonia, occurring 60 days subsequent to the last administration of gefitinib [hematoxylin and eosin staining; magnification, x200 (H) and x400 (I)].
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A chest computed tomography (CT) scan (Fig. 1A) showed multiple small nodules scattered throughout the patient's lungs, suggesting pulmonary metastasis. The patient developed a progressive disease following four cycles of chemotherapy with a pemetrexed-cisplatin regimen, starting in July 2011 (Fig. 1B). In November 2011, daily treatment with oral gefitinib (250 mg/day) was initiated and the patient achieved a partial response one month subsequently (Fig. 1C). A chest CT scan showed interstitial inflammation of the lungs, bilateral pleural effusion and an adverse swelling of the lungs (Fig. 1D). A small quantity of inflammatory exudate was observed in the alveolar cavity (Fig. 1H and I). Table I. The follow-up high-resolution CT scan (Fig. 1E) showed the total resolution of the ground-glass lesions and the absorption of the right-side pleural fluid. One month later, the follow-up chest CT (Fig. 1F) showed no interstitial pneumonia recurrence or tumor progression.