PMC9627657_01
Treatment timeline of the patient.
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The 58-year-old patient was female and visited our hospital for one-month hemoptysis with no history of chronic diseases, smoking, and alcohol use ( Figure 1 ).
Imaging examination. (A-D) Preoperative CT scan; (E) Preoperative DR image; (F) DR image after one cycle of neoadjuvant therapy; (G, H) Preoperative fiberoptic bronchoscopy image; (I-L) CT image after 2 cycles of neoadjuvant therapy.
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Central lung cancer was considered ( Figures 2A-D ). Fiberoptic bronchoscopy indicated neoplasms in the posterior segment of the right upper lung, endoscopic biopsy suggested NSCLC ( Figures 2G, H ), and immunohistochemistry showed P40(+) and TTF-1 (-), suggestive of squamous cell carcinoma ( Figures 3A, B ). The patient's tumor was closely related to the right upper pulmonary artery branch ( Figure 2C ), and the possibility of angioplasty during direct surgery was high, increasing the risk of surgery. In the meantime, chest digital radiography (DR) showed a reduction of the right upper lung occupancy ( Figures 2E, F ), implying partial radiographical response. Besides, positron emission tomography-computed tomography (PET-CT) illustrated an irregular patchy hyperdense shadow (2.76 cm x 2.18 cm x 1.59 cm) near the hilum of the right lung upper lobe and a mild increase in radioactivity uptake (maximum SUV = 2.57, mean SUV = 2.37), indicating that the tumor activity was remarkably suppressed ( Figures 2I-L ).
Examinations of pathology and mIHC. (A, B). Histology of biopsies samples (CT guided biopsy);(C, D) histology of surgical tissue sample; (E, F) mIHC staining of tumor microenvironment of puncture tissue; (G, H) mIHC staining of tumor microenvironment after operation.
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Fiberoptic bronchoscopy indicated neoplasms in the posterior segment of the right upper lung, endoscopic biopsy suggested NSCLC ( Figures 2G, H ), and immunohistochemistry showed P40(+) and TTF-1 (-), suggestive of squamous cell carcinoma ( Figures 3A, B ). Postoperative pathology ( Figures 3C, D )showed that the mass was 2.5 cm x 2 cm x 1.5 cm and that the fibrous tissue of the tumor bed exhibited hyperplasia with degeneration. Biopsy tissues and surgical samples were examined using multiplex immunohistochemistry (mIHC) to reveal the alterations of the tumor microenvironment (TME) after the application of neoadjuvant therapy, especially the inflammatory and immune cells. mIHC of biopsy tissues ( Figures 3E, F ) illustrated intratumoral presence of CD8+ T cells (111/mm2), and high infiltration of FoxP3 (244/mm2) and CD68 + CD163 + M2 macrophages (139/mm2). In the surgical samples ( Figures 3G, H ), large amounts of CD8+ T cells (511/mm2) and tertiary lymphoid structures were observed, while the number of CD68 + CD163 + M2 macrophages (32/mm2) and FoxP3+ (60/mm2) were substantially decreased.