PMC8573260_01
(A1 and A2) The baseline CT scan of the patient's chest in August 2020. (B1 and B2) CT scan of the chest after two cycles of durvalumab in October 2020.
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Active antiemetic and neurotrophic symptomatic treatment were operated then tolerated by the patient. After two cycles of chemotherapy, the patient got the imaging evaluation result as PR (Figure 1B1 and B2).
(A1 and A2) The baseline MRI scan of the patient's head in August 2020. (B1 and B2) MRI scan of the head after the first seizure in October 2020. (C1 and C2) MRI scan of the head after the second seizure.
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A2). After admission to our hospital, the imaging examination result shows that head MRI: white matter change (DWMH (deep white matter hyperintensities) grade I); Cysts of the right maxillary sinus may be involved (Figure 2A1 and A2). The result of pathological histopathology and immunohistochemistry by local bronchoscopy biopsy performed showed that: Small-cell endocrine cancer,TTF1 (+), Napsin-A (-), CK7 (-), ck5/6 (-), p63 (-), CK20 (-), CD56 (+), Syn(partially weak +), CgA (+), Ki-67 index50% (Figure 3A1 and A2). Bronchial stenosis by compression in the left lower lung lobe was observed, and high density patch shadow could be seen at the distal end of the masses, with the radiation uptake uneven and increased, and the SUVmax was about 4.5, which was in line with the signs of central lung cancer with atelectasis of partial distal lung tissue, as well as the signs of obstructive inflammation: multiple lymph nodes with increased FDP metabolism in the left hilum and mediastinum had been observed, metastases were thus considered (Figure 4A1 and A2). Active antiemetic and neurotrophic symptomatic treatment were operated then tolerated by the patient. After two cycles of chemotherapy, the patient got the imaging evaluation result as PR (Figure 1B1 and B2). Urgent examination of head CT and EEG showed no obvious abnormality (Figures 2B1, B2 and 5A), and electrolyte tests showed the result of Na+129mmol/L and Cl- 93.2mmol /L.
(A1 and A2) The result of the lump in the left lung pathological histopathology and immunohistochemistry by local bronchoscopy biopsy performed showed that is small-cell endocrine cancer.
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The result of pathological histopathology and immunohistochemistry by local bronchoscopy biopsy performed showed that: Small-cell endocrine cancer,TTF1 (+), Napsin-A (-), CK7 (-), ck5/6 (-), p63 (-), CK20 (-), CD56 (+), Syn(partially weak +), CgA (+), Ki-67 index50% (Figure 3A1 and A2).
(A1 and A2) PETCT on August 27, 2020; The increased mass of FDG metabolism in the hyperplastic block indicated by the arrow.
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Bronchial stenosis by compression in the left lower lung lobe was observed, and high density patch shadow could be seen at the distal end of the masses, with the radiation uptake uneven and increased, and the SUVmax was about 4.5, which was in line with the signs of central lung cancer with atelectasis of partial distal lung tissue, as well as the signs of obstructive inflammation: multiple lymph nodes with increased FDP metabolism in the left hilum and mediastinum had been observed, metastases were thus considered (Figure 4A1 and A2).
(A) The patient's EEG after the first seizure in October 2020. (B) The patient's EEG after the second seizure in October 2020. The pink box showed EEG becomes abnormal situation with sharp and slow waves.
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Urgent examination of head CT and EEG showed no obvious abnormality (Figures 2B1, B2 and 5A), and electrolyte tests showed the result of Na+129mmol/L and Cl- 93.2mmol /L. EEG showed abnormal situation with sharp and slow waves (Figure 5B); brain MRI showed that there were strip-shaped DWI signals with slightly high intensity and reduced ADC in the left hippocampus.