PMC9376962_01
CT of the lungs at different times. (A-D) Mediastinal Window; (E-F) window of lung fields. (A) Pulmonary lesion before treatment. (B) CT revealed a stable disease after 2 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (C) CT revealed a stable disease after 6 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (D) CT showed no significant changes in the primary lesion of the left lung after sequential 2 cycles of sintilimab immune monotherapy maintenance treatment. (E)The window of lung fields after 6 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (F) CT revealed pulmonary metastases increased after sequential 2 cycles of sintilimab immune monotherapy maintenance treatment (as the red arrow).
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Computed tomography (CT) of the lungs suggested occupancy of the upper lobe of the left lung, about 9.4x5.4cm in size, and invasion of the adjacent left rib pleura, mediastinal and left hilar lymph node enlargement, multiple nodules of 0.3-0.8cm in both lungs (Figure 1A). Solid Tumors 1.1 (RECIST 1.1), chest CT scan confirmed a stable disease (SD, Figure 1B), and the left kidney lesion was assessed as SD (Figure 2B). Continuing the treatments of albumin-bound paclitaxel and cisplatin combined with sintilimab, the efficacy of pulmonary lesions and renal lesions were still evaluated as SD after 6 cycles of treatment (Figures 1C, 2C). Subsequently, the follow-up examination on June 20, 2021, found that after 2 cycles of immune monotherapy maintenance therapy, there were no significant changes in the primary lesion of the left lung (Figure 1D), but new lung metastases occurred (Figures 1F vs. 1E).
Abdominal CT at different times. (A) The left kidney lesion before treatment. (B) CT revealed a stable disease after 2 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (C) CT revealed a stable disease after 6 cycles of albumin-bound paclitaxel and cisplatin in combination with sintilimab. (D) No significant change in left kidney lesion after sequential 2 cycles of sintilimab immune monotherapy maintenance treatment.
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Abdominal CT suggested occupancy in the lower pole of the left kidney with 5.0cm in size (Figure 2A). Solid Tumors 1.1 (RECIST 1.1), chest CT scan confirmed a stable disease (SD, Figure 1B), and the left kidney lesion was assessed as SD (Figure 2B). Continuing the treatments of albumin-bound paclitaxel and cisplatin combined with sintilimab, the efficacy of pulmonary lesions and renal lesions were still evaluated as SD after 6 cycles of treatment (Figures 1C, 2C). Subsequently, the follow-up examination on June 20, 2021, found that after 2 cycles of immune monotherapy maintenance therapy, there were no significant changes in the primary lesion of the left lung (Figure 1D), but new lung metastases occurred (Figures 1F vs. 1E). While the left renal lesion was similar to the previous lesion (Figure 2D).
Whole body bone imaging showed increased radioactivity in the third thoracic vertebra with bone destruction.
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Bone scan suggested metastasis to the 3rd thoracic vertebra (Figure 3), while ultrasound and head CT of the remaining cervical lymph nodes showed no abnormality.
Tissue sections stained with hematoxylin-eosin. (A) Adenocarcinoma of the left lung. (B) Left renal clear cell carcinoma.
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The lung puncture biopsy revealed adenocarcinoma, and immunohistological staining results showed positive for cytokeratin 7 (CK7+), cell proliferation antigen Ki-67(50%+), thyroid transcription factor 1 (TTF-1+), Napsin A+, negative for cytokeratin 20 (CK20-), cytokeratin 5/6 (CK5/6-), tumor suppressor gene P40- (Figure 4A). Renal puncture biopsy suggested RCCC, and immunohistochemistry showed pan cytokeratin (CK-pan+), cytokeratin 7 (CK7+), anticytokeratin (CAM5.2+), Vimentin+, alpha-methylacyl CoA racemase (P504S+), paired box protein-8 (PAX-8+), cluster of differentiation 10 (CD10+), cluster of differentiation 117 (CD117-), cytokeratin 20 (CK20-), transcription factor E3 (TFE3-) (Figure 4B).
PD-L1 protein expression on tumor cells was detected by VENTATA PD-L1(SP263). (A) The results was negative. (B) The results was negative.
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Genetic testing of lung tissues showed point mutations in exon 2 of KRAS gene, and programmed death-ligand 1 (PD-L1) protein expression tests in both lung and kidney tissues were negative (Figures 5A, B).
Time flow chart of the diagnosis and treatment process of this patient. (C2 represents 2 courses of treatment, C4 represents 4 courses of treatment, C6 represents 6 courses of treatment, C2 maintenance therapy represents 2 courses of maintenance therapy).
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He was treated with albumin-bound paclitaxel and cisplatin in combination with sintilimab in one cycle every 21 days (the treatment flow chart was shown in Figure 6).