PMC8264441_01
Contrast chest CT scan before chemotherapy showed a primary mass in the upper lobe of the left lung with mediastinal lymph node metastasis (A1). Histology, including immunostaining, of a biopsy specimen of the lung tumor by transbronchial biopsy. Microscopic images of hematoxylin and eosin staining of small cells with a high N/C ratio showed proliferation (A2). TTF-1 (A3), synaptophysin (A4), and AE1/AE3 (A5) were positive. Contrast-enhanced abdominal CT scan before chemotherapy showed occupied lesions in the pancreas (B1). Histology, including immunostaining, of a biopsy specimen of the pancreatic tumor by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) from the stomach. Hematoxylin and eosin staining showed the proliferation of small cells with a high N/C ratio (B2). TTF-1 (B3), synaptophysin (B4), and AE1/AE3 (B5) were positive.
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The lung tumor was diagnosed as small cell carcinoma via a transbronchial biopsy ( Figure 1A ), and the pancreatic tumor was diagnosed as small cell carcinoma via an endoscopic ultrasound-guided fine needle aspiration biopsy ( Figure 1B ).
Thirty-one days after chemotherapy, Electroencephalogram showed diffuse slow wave (45 Hz) (A). There were no seizures. EEG improved after steroid pulse therapy (B).
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Electroencephalography (EEG) showed a slow wave (4-7 Hz) 31 days after chemotherapy ( Figure 2A ). Figure 2B ). Fifty-six days after the first chemotherapy, she was able to restart carboplatin plus etoposide with 15 mg prednisolone.