PMC6858604_01
Cranial MRI presentations during the whole treatment (from June 26th, 2016 to May 23rd, 2019). (A1/A2) Cranial MRI images on June 26th, 2016. (B1/B2) Cranial MRI images on September 9th, 2016. (C1/C2) Cranial MRI images on October 15th, 2016. (D1/D2) Cranial MRI images on January 6th, 2017. (E1/E2) Cranial MRI images on February 27th, 2017. (F1/F2) Cranial MRI images on May 19th, 2017. (G1/G2) Cranial MRI images on July 1st, 2017. (H1/H2) Cranial MRI images on September 23rd, 2017. (I1/I2) Cranial MRI images on January 6th, 2018. (J1/J2) Cranial MRI images on March 29th, 2018. (K1/K2) Cranial MRI images on June 1st, 2018. (L1/L2) Cranial MRI images on August 20th, 2018. (M1/M2) Cranial MRI images on October 19th, 2018. (N1/N2) Cranial MRI images on December 27th, 2018. (O1/O2) Cranial MRI images on March 7th, 2019. (P1/P2) Cranial MRI images on May 23rd, 2019.
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According to the findings of cranial magnetic resonance imaging (MRI), two lesions in the brain with surrounding edema were detected in the parietal lobe and occipital lobe, separately (Figure 1, A1/A2). Subsequent chest computed tomography (CT) showed a thoracic mass in the right upper lung (Figure 2, A1), with enlarged mediastinal lymph nodes suggesting metastases (Figure 2, A2). Figure 2, B1/B2). From then on, the patient received another 31 months of maintenance therapy (bevacizumab 7.5 mg/kg plus pemetrexed 500 mg/m2 day 1, every twenty-one days) until June 28th, 2019. During the whole period of maintenance therapy, he received imaging review regularly every one to two months (cranial MRI in Figure 1, from C1/C2 to P1/P2; chest CT in Figure 2, from C1/C2 to X1/X2). During the first follow-up on September 9th, 2016, the primary tumor in the right upper lobe was found empty (Figure 2, B1), the status of which sustained to the seventeenth follow-up on August 20th, 2018 (Figure 2, Q1). On October 28th, 2018, the chest CT scan revealed an emerging streak, high-density mass in the original location in the right upper lung (Figure 2, R1). In addition, the shrunken lesions in the brain and mediastinum still remained stable (Figure 1, N1/N2; Figure 2, R2).
Chest CT presentations during the whole treatment (from June 26th, 2016 to June 3rd, 2019). (A1/A2) Chest CT images on June 26th, 2016. (B1/B2) Chest CT images on September 9th, 2016. (C1/C2) Chest CT images on October 15th, 2016. (D1/D2) Chest CT images on December 2nd, 2016. (E1/E2) Chest CT images on January 7th, 2017. (F1/F2) Chest CT images on March 1st, 2017. (G1/G2) Chest CT images on May 19th, 2017. (H1/H2) Chest CT images on July 14th, 2017. (I1/I2) Chest CT images on August 26th, 2017. (J1/J2) Chest CT images on September 7th, 2017. (K1/K2) Chest CT images on November 2nd, 2017. (L1/L2) Chest CT images on December 23rd, 2017. (M1/M2) Chest CT images on February 18th, 2018. (N1/N2) Chest CT images on April 8th, 2018. (O1/O2) Chest CT images on April 27th, 2018. (P1/P2) Chest CT images on June 1st, 2018. (Q1/Q2) Chest CT images on August 20th, 2018. (R1/R2) Chest CT images on October 28th, 2018. (S1/S2) Chest CT images on November 21st, 2018. (T1/T2) Chest CT images on January 9th, 2019. (U1/U2) Chest CT images on March 5th, 2019. (V1/V2) Chest CT images on March 17th, 2019. (W1/W2) Chest CT images on May 21st, 2019. (X1/X2) Chest CT images on June 3rd, 2019.
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Subsequent chest computed tomography (CT) showed a thoracic mass in the right upper lung (Figure 2, A1), with enlarged mediastinal lymph nodes suggesting metastases (Figure 2, A2). Figure 2, B1/B2). From then on, the patient received another 31 months of maintenance therapy (bevacizumab 7.5 mg/kg plus pemetrexed 500 mg/m2 day 1, every twenty-one days) until June 28th, 2019. During the whole period of maintenance therapy, he received imaging review regularly every one to two months (cranial MRI in Figure 1, from C1/C2 to P1/P2; chest CT in Figure 2, from C1/C2 to X1/X2). During the first follow-up on September 9th, 2016, the primary tumor in the right upper lobe was found empty (Figure 2, B1), the status of which sustained to the seventeenth follow-up on August 20th, 2018 (Figure 2, Q1). On October 28th, 2018, the chest CT scan revealed an emerging streak, high-density mass in the original location in the right upper lung (Figure 2, R1). In addition, the shrunken lesions in the brain and mediastinum still remained stable (Figure 1, N1/N2; Figure 2, R2).
Histological finding with hematoxylin and eosin-stained biopsy specimen from percutaneous lung biopsy on June 30th, 2016.
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Based on the biopsy findings from transthoracic needle pneumocentesis (Figure 3), the patient was finally diagnosed as lung adenocarcinoma with metastases on the mediastinal lymph nodes and brain, suggesting metastatic disease, according to the American Joint Committee on Cancer staging system, seventh edition.
PET-CT presentations on June 28th, 2019. (A) Residual scar in the lung without FDG uptake. (B) Residual scar in the mediastinum without FDG uptake. (C) Residual scar in the brain without FDG uptake. (D) Residual scar in the brain without FDG uptake.
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As a result, there was no obvious beta-2-[18F]-fluoro-2-deoxy-D-glucose (FDG) uptake detected for the suspicious lesions in the lung, brain, or mediastinum, suggesting residual scars (Figure 4).
The variation of tumor markers including CEA (normal range, 0 to 5 ng/mL), CA72-4 (normal range, 0 to 6.9 U/mL), SCC (normal range, 0 to 1.5 ng/mL), and CA19-9 (normal range, 0 to 37 U/mL) for each visit from the initial treatment to the present.
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The variations of tumor markers including CEA, SCC, CA72-4, and CA19-9 during the whole treatment are presented in Figure 5.