PMC8264298_01
Initial diagnosis of advanced undifferentiated large-cell lung cancer with rare tonsillar metastasis. (A) Tonsillar metastasis. (B) Pathology and immunohistochemistry of tonsillar metastasis [KI-67 (40%+); TTF1 (+-)]. (C) Primary lung lesion shown by chest CT. (D) Pathology and immunohistochemistry of the primary lung lesion [KI-67 (50%+); CGA (-; SYN (-)].
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Laryngoscopy revealed a tonsil mass ( Figure 1A ). Chest computed tomography (CT) (January 16, 2019) showed a mass of 78 * 51 mm in the upper left mediastinum ( Figure 1C ). Cranial magnetic resonance imaging (MRI), abdominal CT, and whole body bone scan examinations showed no other metastatic lesions ( Supplementary Figure 1 ). The TTF1 immunohistochemical results suggested that the lesion might originate from the lung ( Figure 1B ). The results of assessment of neuroendocrine-related immunohistochemical indexes, including CGA and SYN, were negative, indicating that the tumor may not have neuroendocrine function ( Figure 1D ). A re-examination of head and neck CT showed no new lesions in the tonsils ( Supplementary Figure 1 ).
Graphic summary of the case.
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As shown in  Figure 2 , from February 15, 2019, the patient received albumin-bound paclitaxel (200 mg on d 1 and 8) + carboplatin (450 mg on d 1) chemotherapy for four cycles.