PMC5754292_01
Chest computed tomography scanning. (a) Two primary lesions in the right upper lung lobe; (b) the disease reached partial remission after two cycles of chemotherapy; (c) disease progression was observed after six cycles of chemotherapy; (d) lesions were significantly reduced after taking Iressa for one month; (e) disease progression after TKI administration for five months; and (f) lesions in the lung remained stable after administration of AZD9291 for six weeks.
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Computed tomography (CT) revealed two lesions in the right upper lung lobe (Fig 1a). The patient achieved a partial response (PR) and hemoptysis disappeared after two cycles of chemotherapy (Fig 1b). However, six cycles later, the disease progressed and the tumor mass was enlarged (Fig 1c). A PR was achieved and the cough was relieved after one month of gefitinib treatment (Fig 1d). He had a severe cough and airway obstruction (Fig 1e) and new metastasizing lesions had appeared, including subcutaneous, intracranial, and intramuscular metastases. The patient was admitted to the ASTRIS clinical trial and started taking AZD9291 (80 mg per day). The disease remained stable for six weeks (Fig 1f), and clinical symptoms such as fatigue, anhelation, and coughing were relieved; his performance status score decreased; and all subcutaneous lesions reduced in size.
Hematoxylin and eosin (H&E) x200 and immunohistochemical staining of biopsy tissues. (a) H&E staining of bronchoscopic biopsy tissue. Tumor cells were positive for (b) p63 and (c) p40 and negative for (d) TTF1, indicating poorly differentiated squamous cell carcinoma. (e) H&E staining of re-biopsy tissues in subcutaneous metastases, small cells were observed in the sample. Immunohistochemical staining of the tissue shows (f) positive for CK5/6 and (g) negative for Synaptophysin A, (h) CD56, and (i) chromogranin, which verified the diagnosis of squamous cell lung cancer.
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TTF-1 and CK 20, favoring a diagnosis of poorly differentiated squamous cell carcinoma (Fig 2a-d). Together with the results of bone scanning and magnetic resonance imaging, the patient was diagnosed with stage IV squamous cell lung cancer with multiple bone metastases. A needle re-biopsy was performed at the subcutaneous lesion, in which pathologists found small cells (Fig 2e). Immunohistochemical staining results positive for CK5/6 and negative for Synaptophysin A, CD56, and chromogranin verified the diagnosis of SQCLC (Fig 2f-i).