PMC7311097_01
CT lung scan results.. Notes: (A-C) Thoracic CT on November 2, 2017 revealed a new-onset nodule located in the LLL. (A) Transverse view; (B) coronal view; (C) sagittal view; (D) thoracic CT demonstrated CR after three cycles of chemotherapy with R-CDOP. (E-G) Lung CT in August 2019 still showed a CR status. (E) Transverse view; (F) coronal view; (G) sagittal view.. Abbreviations: CT, computed tomography; LLL, left lower lobe of lung; CR, complete remission; R-CDOP, rituximab, cyclophosphamide, vindesine, doxorubicin liposome, and prednisone.
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November 2017, the patient had routine follow-up visit and did not report cough, chest pain, fever, night sweats, or weight loss. No superficial enlarged lymph nodes were palpable on physical examination, but thoracic CT scan found a subpleural nodule measuring about 1.5 cmx1.5 cm located in the inferior lobe of the left lung and connected to adjacent pleura with a broad basal pattern (Figure 1A-C). After three cycles, lung CT showed a complete remission (CR) response (Figure 1D). At the patient's most recent follow-up in August 2019, her quality of life was good, lung CT demonstrated CR status (Figure 1E-G), and her disease-free survival (DFS) had reached 21 months.
Whole-body PET/CT findings.. Notes: PET/CT demonstrated a subpleural hypermetabolic nodule in the LLL measuring about 1.5cmx1.5cm with SUVmax of 14.9. This nodule had an unclear boundary with the adjacent pleura (A, PET images; B, CT images; C, fused PET/CT images of the FDG-avid lung lesion; D, coronal image of whole-body PET).. Abbreviations: PET, positron emission tomography; CT, computed tomography; LLL, left lower lobe of lung; SUVmax, maximum of standard uptake value; FDG, fluorodeoxyglucose.
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In view of her history of breast cancer and multiple bone involvement, lung metastasis was considered (Figure 2).
Pathological results of the pulmonary lesion biopsy.. Notes: (A) HE staining showing infiltration of medium to large tumor cells with obvious nuclear atypia, nucleoli, vacuolar chromatin, and invasion of small vessels (original magnification, 400x). (B) The neoplasm exhibited a high Ki-67 proliferation index (80%, original magnification, 200x) and stained positive for CD20 (C, original magnification, 200x), Bcl-2 (D, original magnification, 200x), Bcl-6 (E, original magnification, 200x), and MUM1 (F, original magnification, 200x) but negative for CD10 (G, original magnification, 200x), cyclin D1 (H, original magnification, 200x) and CD5 (I, original magnification, 200x). (J) Epstein-Barr virus encoded RNA in situ hybridization was negative (original magnification, 200x).. Abbreviations: HE, hematoxylin-eosin; CD, cluster of differentiation; RNA, ribonucleic acid.
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A percutaneous lung lesion biopsy revealed diffuse medium to large neoplastic cells with obvious nuclear atypia, obvious nucleoli, vacuolar chromatin, and invasion of small vessels (Figure 3A). The neoplasm exhibited a high Ki-67 proliferation index of 80% (Figure 3B). Tumor cells were strongly immunoreactive to CD20 (Figure 3C), Bcl-2 (Figure 3D), Bcl-6 (Figure 3E), and MUM1 (Figure 3F) but negative for CD10 (Figure 3G) and cyclin D1 (Figure 3H). Tumor immunohistochemistry showed PAX-5 (+), CD5 (-) (Figure 3I), and c-Myc (30%+). Epstein-Barr virus encoded RNA in situ hybridization was negative (Figure 3J).
Whole-body PET/CT after four cycles of R-CDOP demonstrated CR.. Notes: (A) PET images; (B) CT images; (C) fused PET/CT images; (D) coronal image of whole-body PET.. Abbreviations: PET, positron emission tomography; CT, computed tomography; R-CDOP, rituximab, cyclophosphamide, vindesine, doxorubicin liposome, and prednisone; CR, complete remission.
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Whole-body PET-CT also confirmed CR after four cycles of R-CDOP (Figure 4).