Figures at a glance

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FIGURE 1

Figure 1: Baseline physical examination results of the patient at initial presentation. (A) PET-CT at initial examination indicated a hypermetabolic region, marked by a red arrow , which was considered malignant. (B) Pathological examination, HE staining of the puncture biopsy section showed malignant.

FIGURE 2

Figure 2: Treatment effect after one cycle of chemotherapy. The red arrows highlighted a significant reduction in the left hilar mass and mediastinal lymph nodes compared to the findings observed on PET-CT on February 6th, 2013 (partial response).

FIGURE 3

Figure 3: The patient benefited from local treatment. (A) The patient's upper abdominal enhancement CT on October 20th, 2014 revealed a new mass in the left adrenal gland, indicated by the arrow, which was considered to be a tumor recurrence. (B) After local radiotherapy, the left adrenal mass significantly reduced in size compared to before radiotherapy. (C) A repeat chest CT on October 16th, 2017 revealed an enlargement of a new metastatic lymph node on the left supraclavicular side. (D) The left supraclavicular lymph node was significantly smaller than before. (E) Increased metabolism of the periaortic lymph node, which was considered malignant. (F) Long T2 signal indicated by the arrow, suggested multiple metastases in the liver.

FIGURE 4

Figure 4: The patient benefited from the immunotherapy. (A) PET-CT showed that the right parietal, left parietal, and left parietal iliac vessels lymph nodes of the abdominal aorta were larger than before, and the metabolism was increased as indicated by the arrows. (B) The metabolism of the left parietal abdominal aortic lymph nodes was lower than before after PD1 treatment, as indicated by the arrow

FIGURE 5

Figure 5: Targeted anti-vascular treatment benefited the patient. (A, B) Abdominal CT showed enlarged lymph nodes around the hepatoportal and in front of the right renal vein; soft tissue nodules under the right renal portal with significant enhancement. These nodules encircled the right upper ureter, resulting in dilated right hydronephrosis, which newly occurred. (C, D) The right subglottic lesion indicated by arrows was smaller than before, and the periportal lymph nodes were stable

FIGURE 6

Figure 6: Immune rechallenge stage. (A) The metastases in both adrenal glands were larger than before, with the right side being particularly obvious, as indicated by the arrow. The mass also showed uneven enhancement. (B) The left adrenal mass was stable after immunotherapy.