PMC5568879_01
Images of the chest CT (A, D) before the treatment showed an aspergilloma located in the left thoracic cavity (A). However, it was difficult to detect a mass in the right mainstem bronchus and marked lymph nodes swelling (A, D). Images from white-light (B) and autofluorescence (C) bronchoscopy demonstrated a polypoid lesion in the right mainstem bronchus that is shown in magenta in the autofluorescence image.
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A 37-year-old male developed an aspergilloma in the postoperative left thoracic cavity after receiving concurrent chemoradiotherapy for mediastinal type lung adenocarcionoma and subsequent left upper lobectomy for heterochronous dual adenocarcinoma (Fig. 1A). When fiberoptic bronchoscopy (FOB) was performed, a polypoid lesion was observed in the right mainstem bronchus (Fig. 1B) that exhibited magenta in an autofluorescence image (Fig. 1C). Contrast-enhanced CT of the chest did not show the tumor, its invasion into the bronchial cartilage, or apparent metastases into the regional lymph nodes (Fig. 1D).
Images of fiberoptic bronchoscopy (FOB) obtained on day 22 of the 4th cycle before (A) and after (B) treatment by argon plasma coagulation (APC) are shown. A scar-like lesion was observed (A), and APC was conducted by using appropriate settings (B). Images of chest CT (C) and FOB (D) obtained 24 months after the APC are shown. Chest CT showed the postoperative status of the left cavernostomy and no abnormalities in the right mainstem bronchus were found (C). A scar-like epithelial thickening was observed by white-light bronchoscopy (D).
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APC was employed for local treatment on day 22 of the 4th cycle in order to have local control. An image from a FOB session on day 22 prior to APC is shown in Fig. 2A. The color of the bronchial mucosa became brown inside of the preset margin area after the end of the entire procedure (Fig. 2B). CT of the chest and FOB showed only a scar-like lesion (Fig. 2C and D, respectively). Considering the aggressive nature and high malignant potential of SCLC, the disease was completely resolved by the combination of chemotherapy and APC.