PMC9150760_01
A 16-slice computed tomographic scan revealed a left lung nodule superior lobe (2.8x1.2 cm) anterior segment. The nodule had a spiculated sign, pleural indentation, vessel convergence, and multiple burr shadows on the edges.
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His chest computed tomography (CT) scan showed a 2.8 x 1.2 cm patchy, slightly high-density shadow on the upper lobe of the left lung, and there were multiple burr shadows around the edges (see Figure 1).
A 16-slice computed tomographic scan revealed a high-density nodule in the fourth thoracic vertebra.
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In addition, the 4th (see Figure 2), 5th, 6th, 10th, 12th thoracic vertebrae, 4th lumbar vertebrae, 3rd right anterior rib, 5th left costal axillary side, 8th left posterior rib, right sacroiliac joint, right hip joint, right inferior ramus of pubis, left middle and upper femur, right proximal radial bone showed nodular and slightly high-density shadows.
A 99mTc-MDP bone scan revealed bone metastases at the 4th, 5th, 6th, 10th, and 12th thoracic vertebrae and 4th lumbar vertebrae.
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Bone metastases were also confirmed by a 99mTc-MDP bone scan (see Figure 3), in which the bone showed vigorous metabolism.
An enlarged lymph node that can be touched on the surface of the body is proven to be structurally abnormal by color ultrasound and is eventually used for pathological biopsy.
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Considering that the multiple metastases could not be completely resected, we identified ipsilateral supraclavicular lymph nodes with metastases by ultrasound (see Figure 4).
Image of histologic diagnosis using hematoxylin and eosin staining (original x200), which revealed lung adenocarcinoma metastasis.
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The pathologic findings suggested lung adenocarcinoma (Figure 5) and PCK (+), TTF (+), CK7 (+), Napsin A (+), CDX2 (-), Villin (-), P40 (-), Syn (-), and Ki67 (5-10%).
A 16-slice computed tomographic scan revealed that the left lung nodule was significantly smaller than before and was almost absorbed.
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After two months of treatment with icotinib hydrochloride only, pulmonary nodules were basically absent on chest CT scan re-examination (see Figure 6).
A 99mTc-MDP bone scan revealed that the bone metastases were absorbed.
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Subsequently, the patient's nuclear medicine doctors were surprised to find that the bone metastatic lesions had disappeared on the follow-up 99mTc-MDP bone scan and CT scan (see Figures 7 and 8) nine months after the initiation of icotinib hydrochloride monotherapy.
A 16-slice computed tomographic scan revealed that the high-density nodule in the fourth thoracic vertebra was absorbed.
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Subsequently, the patient's nuclear medicine doctors were surprised to find that the bone metastatic lesions had disappeared on the follow-up 99mTc-MDP bone scan and CT scan (see Figures 7 and 8) nine months after the initiation of icotinib hydrochloride monotherapy.