PMC8546288_01
Chest CT. The arrow points to the tumor site. (a) At initial diagnosis, (b) after closed drainage of the right chest, and (c) after targeted therapy of gefitinib.
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Her chest computed tomography (CT) showed space-occupying lesions in the right hilum and enlarged lymph nodes in the mediastinum, atelectasis of the right lung, massive pleural effusion in the right side, and multiple nodules in both lungs (Figure 1a). Right thoracic closed drainage and pleural biopsy were performed, resulting in a total of 1,500 mL yellow pleural fluid drained out (Figure 1b) and a pleural fluid CEA of 17.55 ng/mL. The cancer lesions in lungs of the patient were significantly reduced (Figure 1c) after gefitinib and did not progress during the treatment period.
Multiple BMs revealed by MRI. (a and b), (c and d), and (e and f) are image comparison of the same part, respectively. (a), (c), and (e) At initial visit, (b) and (d) after targeted therapy of gefitinib, and (f) a new metastasis was found in the right cerebellar hemisphere.
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Magnetic resonance imaging (MRI) showed gadolinium-enhanced multiple abnormal intensification foci in the brain which were considered to be multiple metastatic tumors (Figure 2a, c, and e). The patient received gefitinib and intermittent zoledronic acid for bone metastases until 20 months, and then MRI showed that BMs which had disappeared and shrunk (Figure 2b and d) after gefitinib were progressing again.
Hematoxylin-eosin-stained biopsy specimens. (a) (10*10) and (b) (40*10) showed the pathology of pleural biopsy specimens: Well-differentiated adenocarcinoma infiltration in small fibrous tissue, immunohistochemical feature: CK (+) EMA (-) Vim (-) MC (-) CR (-) P53 (-) Ki-67 (2% +) CK7 (-) TTF-1 (-) Villin (-) CK 20 (-) CDX-2 (-) CEA (-). (c) (10*10) and (d) (40*10) showed the pathology of bronchoscopic biopsy specimens: (right lower lobe bronchial orifice) infiltrating adenocarcinoma, tumor thrombus was found in vascular cavity, immunohistochemical feature CK7 (+) TTF-1 (+) CEA (+) CK (+) CD31 (vascular+, tumor thrombus visible).
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The histology of the pathological changes confirmed by both pleural biopsy (Figure 3a and b) and fiberoptic bronchofiberscopy biopsy (Figure 3c and d) was adenocarcinoma of the lung.
Systemic bone imaging. The metabolic activity of hypermetabolic focus in the middle part of left femur decreased significantly after treatment. (a) At the initial visit and (b) after targeted treatment of gefitinib.
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One month later, the patient underwent a systemic bone imaging examination, which revealed abnormal bone metabolism in the middle of the left femur (Figure 4a). Systemic bone imaging showed that the metabolic activity of hypermetabolic lesions in the middle part of the left femur was significantly decreased after gefitinib treatment (Figure 4b) and the patient had never been affected by lower limb discomfort.