PMC7471814_01
Fiberoptic bronchoscopy and PET/CT images. (a) Fiberoptic bronchoscopy revealed intratracheal mass in right main bronchi with complete right mainstem bronchus occlusion before treatment. (b) PET/CT image showing left hilum and mediastinal mass (41 x 87 x 76 mm, FDG uptake 20.6) with compression of the pulmonary artery, lower tracheal segment, bilateral main bronchi, and superior vena cava. (c) Right mainstem bronchus was completely occluded, and a tracheal stent was implanted. (d) Bronchus occlusion was significantly improved after treatment with PD-1 inhibitor and DNMTi/HDACi. (e) Restaging PET image showing dramatically shrinkage of hilum and mediastinal mass (16 x 15 mm, FDG uptake 8.0) after a triple combination treatment of DNMTi/HDACi plus PD-1 inhibitor.
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Fiberoptic bronchoscopy revealed intratracheal mass in right main bronchi with complete right mainstem bronchus occlusion (Figure 1(a)). Initial fluorodeoxyglucose positron emission tomography (FDG-PET) revealed left hilum and mediastinal mass (41 x 87 x 76 mm, FDG uptake 20.6) with compression of the pulmonary artery, lower tracheal segment, bilateral main bronchi, and superior vena cava (Figure 1(b)). However, the patient developed respiratory distress soon, and a tracheal stent was implanted into the completely occluded bronchus (Figure 1(c)). Bilateral bronchus was clear, and restaging PET 2 weeks later revealed over 90% shrinkage of hilum and mediastinal mass (16 x 15 mm, FDG uptake 8.0, PET-CT score 5) and significant improvement of bronchus occlusion (Figures 1(d) and 1(e)).
Immunohistochemical characteristics of tumor cells. (a) Transbronchial biopsy of the mediastinal mass (H&E staining) showing a diffuse proliferation of atypical medium- to large-sized lymphoid cells. (b) CD20-positive neoplastic cells from mediastinal biopsy aspirate. (c) BCL6-positive neoplastic cells (70%) from mediastinal biopsy aspirate. (d) BCL2-positive neoplastic cells (95%) from mediastinal biopsy aspirate. (e) P53-positive neoplastic cells from mediastinal biopsy aspirate. (f) PD-L1-positive neoplastic cells from mediastinal biopsy aspirate.
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They are negative for CD3, CD5, and CD10. The Ki67 proliferative fraction is 80%+ (Figure 2).