PMC9321640_01
(A) CT of the patient's chest (July 10, 2018) shows: Massive soft tissue-like density shadows can be seen near the hilar of the right upper lung, the size is about 11.4cm* 10.7cm, the enhanced scan is uneven and moderately enhanced; (B) The patient's chest CT (September 11, 2018) after VAI regimen chemotherapy showed that the size of the right lung mass was about 8.9*8.1 cm, which was smaller than before, but the mediastinal lymph nodes were enlarged; (C) (September 30,2018) The size of the right lung mass is about 12.1cm*10.5 cm, which is larger than before. (D) (October 11, 2018) The soft tissue-like density shadow of the right upper lobe of the right lung mass, the right hilum is compressed, the main trachea of the right lower lung is compressed and narrowed, and the righthilar and mediastinum have multiple enlarged lymph nodes.
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Enhanced scanning lesions were uneven and moderately enhanced, and multiple swollen lymph nodes in the mediastinum ( Figure 1A ). Ruubicin + ifosfamide each chemotherapy cycle for 1 cycle, after the completion of 2 cycles of chemotherapy, the chest CT was reexamined to assess the reduction of tumor lesions ( Figure 1B ). After continuing to use the VAI regimen for 1 cycle of chemotherapy, the patient developed superior vena cava compression syndrome, edema of the face and upper extremities, difficulty breathing, and unable to lie supine ( Figure 1C ). On October 11, 2018, the patient's right lung tumor continued to progress ( Figure 1D ), and the radiotherapy ended, and a total of 13 radiotherapy sessions were performed.
(A) Tumor small-medium size, fine nuclear staining, no nucleoli (HE, 10X); (B) Tumor small-medium size, fine nuclear staining, no nucleoli (HE, 40X); (C) 1.P40 positive(Immunohistochemical staining); 2. TTF-1 positive (Immunohistochemical staining); 3. SyN positive (Immunohistochemical staining); NUT positive (Immunohistochemical staining); (D) Fluorescence in situ hybridization (FISH) display: 45% of tumor cells show red and green separation signals (DAPI color development, 1000X).
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Hospital of Zhengzhou University: poorly differentiated cancer, tumor cells are undifferentiated, small-medium size cells, round, oval, or short spindle-shaped nuclei, fine nuclear chromatin, no obvious nucleoli ( Figures 2A, B ). According to the morphology, the first consideration is small cell carcinoma. However, the immunohistochemically labeled tumor cells express squamous cell carcinoma markers such as P40 and CK5/6, and also the adenocarcinoma marker TTF-1. NUT has suspicious positive cells ( Figure 2C ) simultaneously. The FISH test result returned: 45% of tumor cells showed separation of NUT red and green signals ( Figure 2D ). The final pathological diagnosis: (right lung biopsy) poorly differentiated cancer, in line with NUT midline cancer.