PMC9852634_01
A flow chart of the entire treatment course. Red circles indicate the target lesion. VATS, video-assisted thoracic surgery; DDP, cis-diamminedichloroplatinum; CT-MWA, CT Guided Microwave Ablation.
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The patient, a 61-year-old female, was found to have a right lower lung occupancy of 2.0 cm in size by chest computed tomography (CT) on April 13, 2013 (Figure 1A), and then hospitalized. On October 23, 2018, a soft tissue density occupancy in surgery area with pleural invasion was found by chest CT (Figure 1C), and the possibility of lung cancer recurrence was considered. In conjunction with the second molecular testing report: EGFR Exon19 Deletion mutant, the patient received gefitinib (Iressa) as the first-line treatment, and the right lung lesion was found rapidly shrunk on February 26, 2019 (Figure 1D), which proved that the treatment was effective. On January 7, 2021, a lesion was found in the middle lobe of right lung during reexamination, about 8 mm (Figure 1E). On May 7, 2021, the lesion was found to be progressively enlarged, approximately 10 mm in size (Figure 1F). Radiographic examination suggested a high probability of tumor (Supplementary Figure S1). On July 13, 2021, the chest CT showed that the right middle lung mass with peripheral speckles and cords, which was considered as changes after microwave ablation (Figure 1G). With regular follow-up to May 2022 (Figure 1H), no obvious abnormality was found, which proves a good outcome. The whole therapy process of the patient is shown in Figure 1.
Tumor indicator levels when discovering lesions. AFP, alpha fetoprotein; CEA, carcinoembryonic antigen; NSE, neuron-specific enolase; CYFRA21-1, cytokeratin 19 fragment; CA125, carbohydrate antigen 125; CA19-9, carbohydrate antigen 19-9; CA15-3, carbohydrate antigen 15-3.
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Tumor indicators: Alpha-fetoprotein (AFP): 3.39 ng/ml; Carcinoembryonic antigen (CEA): 1.30 ng/ml; Carbohydrate antigen (CA) 125: 3.30 U/ml; CA 19-9: 3.80 U/ml; Cytokeratin 19 fragments (CYFRA21-1): 2.0 ng/ml; Neuron-specific enolase (NSE): 14.10 ng/ml; CA 15-3: 5.1 U/ml (Figure 2). Tumor indices: AFP: 2.85 ng/ml; CEA: 1.10 ng/ml; CA 125: 17.70 U/ml; CA 19-9: 6.40 U/ml; CYFRA21-1: 4.72 ng/ml; NSE: 13.90 ng/ml; CA 15-3: 7.30 U/ml (Figure 2). Tumor indicators: AFP: 2.39 ng/ml; CEA: 0.97 ng/ml; CA 125: 2.50 U/ml; CA 19-9: 2.50 U/ml; CYFRA21-1: 3.22 ng/ml; NSE: 13.31 ng/ml; CA 15-3: 6.40 U/ml (Figure 2). CT, bone scan and so on. Considering the higher risk of surgical bleeding and the relatively less benefit of reoperation after recurrence, CT Guided Microwave Ablation was performed on June 16, 2021, and the pathological biopsy during microwave therapy was confirmed to be adenocarcinoma (Supplementary Figure S2).
Pathological diagnosis of lesions. (A,B) Invasive adenocarcinoma grade II-III (alveolar dominant type). IHC revealed CK7+, CK5/6-, P63+, CK51+, TTF1+, SPA+, P16+, ER+ (20%), PR+ (10%), DOG1-. (HE4X/10X). (C) Chronic granulomatous inflammation with mechanization. (D) Invasive non-mucinous adenocarcinoma.
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II-III (alveolar predominant type), invading the dirty pleura (Figures 3A,B). "Group 10 lymph nodes" (0/1) and "Group 11 lymph nodes" (0/2). Immunohistochemistry: CK7+, CK5/6-, P63+, CK51+, TTF1+, spa+, P16+, ER+ (20%), PR+ (10%), DOG1-. October 30, 2018, the percutaneous aspiration biopsy of lung (PABL) was performed, and the pathology manifested chronic granulomatous inflammation with mechanization (Figure 3C). On November 6, 2018, positron emission tomography (PET-CT) showed a mass-like hyperdense shadow in the lower lobe of the right lung with abnormal increased glucose metabolism, considering the high possibility of lung cancer recurrence. On November 15, 2018, the second PABL was performed and the pathology of the right lower lung puncture tissue showed invasive non-mucinous adenocarcinoma (Figure 3D).