PMC9259980_01
Radiologic findings and histological features of small cell lung cancer (poorly differentiated neuroendocrine carcinoma). Chest X-ray examination showed a mass of high density in right middle lobe (A), which was presented more clearly by CT (B). Brain MRI confirmed metastasis in cerebellar tonsillar (C). H&E staining performed is shown in panels (D-F), which were magnified by x100, x200, and x400, respectively. Further immunohistochemistry staining showed CK7(+) (G), TIF-1(+) (H), SYN(+) (I), CD56(+) (J), and ki-67 (60% +) (K), all with magnification of x200.
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Figure 1A ). Further CT-guided percutaneous lung biopsy of these lung nodules was performed on November 10, 2021. One week later, biopsy pathology revealed CK7(+), TIF-1(+), SYN(+), CD56(+), and ki-67 (60% +), confirming that it was poorly differentiated neuroendocrine carcinoma (SCLC) ( Figures 1B, D-K ). Brain MRI confirmed metastasis of lung cancer in the cerebellar tonsillar ( Figure 1C ).
Endoscopic and histological features of immune checkpoint inhibitor (ICI)-related colitis. Endoscopic images of colons revealed that mucosal congestion, edema, rough, unclear perivascular texture, multiple superficial ulcers with purulent secretions, and white moss existed among transverse colon (A), descending colon (B), sigmoid colon (C), and rectum (D). H&E staining performed is shown in panels (E-H), all with magnification of x100. Histology images courtesy of Qiongyi Huang.
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Subsequent colonoscopy showed severe mucosal inflammation from the transverse colon to the anus with multiple ulcerations attached with purulent secretions and moss, consistent with Mayo endoscopic subscore of 3 ( Figures 2A-D ). Histopathological analysis of colon biopsies revealed that there was multiple purulent exudation and necrosis, and colonic crypt atrophy or rupture, suggestive of acute enteritis ( Figures 2E-H ).
Timeline of medications administered to the patient. SCLC, small cell lung cancer.
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We immediately switched to total parenteral nutrition on December 7, 2021, and 300 mg of anti-integrin mAb (i.e., vedolizumab; Takeda GmbH, Konstanz, Germany) was administered to the patient to strengthen immunosuppression on December 11, 2021 ( Figure 3 ).