Significant benefits of pembrolizumab in treating refractory advanced pulmonary sarcomatoid carcinoma: A case report

Figure 1 Imaging examinations. A: Primary cancer in the apical segment of the upper lobe of the right lung before surgery in the lung window (yellow arrow); B: Primary cancer in the apical segment of the upper lobe of the right lung before surgery in the mediastinal window (orange arrow); C: No bone metastasis existed before surgery at baseline; D: right lung metastasis 1 mo after surgery (orange arrow); E: left lung metastasis 1 mo after surgery (orange arrow); F: Bone metastases 1 mo after surgery (orange arrow); G: Adrenal gland metastases 1 mo after surgery (orange arrow).

Figure 2 Pathological images of the surgical specimens. A and B: Pulmonary sarcomatoid carcinoma was diagnosed (A: hematoxylin and eosin [H&E] staining, 100 ×; B: H&E staining, 200 ×); C and D: Adenocarcinoma also present (C: H&E staining, 100 ×; D: H&E staining, 200 ×); E and F: Immunohistochemical staining showed that the tumor cells were positive for programmed death-ligand 1 expression, tumor proportion score: 90% (E: pulmonary sarcomatoid carcinoma, immunohistochemical staining, 200 ×; F: adenocarcinoma, immunohistochemical staining, 200 ×).

Figure 3 Sequence of antitumor treatments across the timeline. TC: Paclitaxel plus carboplatin; WBRT: Radiotherapy to the right chest wall.

Figure 4 Tumor changes with pembrolizumab treatment. A: Thyroid gland metastasis before pembrolizumab (orange arrow); B: Thyroid gland metastasis shrank obviously after 2 mo of pembrolizumab; C: Thyroid gland metastasis shrank obviously after 4.5 mo of pembrolizumab; D: Thyroid gland metastasis was still well controlled after 8 mo of pembrolizumab; E: Oropharynx left anterior wall metastasis before pembrolizumab (orange arrow); F: Oropharynx left anterior wall metastasis shrank obviously after 2 mo of pembrolizumab; G: oropharynx left anterior wall metastasis shrank obviously after 4.5 mo of pembrolizumab; H: Oropharynx left anterior wall metastasis was still well controlled after 8 mo of pembrolizumab; I: Left lung metastasis before pembrolizumab (orange arrow); J: Left lung metastasis shrank obviously after 2 mo of pembrolizumab; K: Left lung metastasis shrank obviously after 4.5 mo of pembrolizumab; L: Left lung metastasis was still well controlled after 8 mo of pembrolizumab; M: Right adrenal gland metastasis before pembrolizumab (orange arrow), spleen metastasis before pembrolizumab (white arrow); N: right adrenal gland metastasis shrank after 2 mo of pembrolizumab (orange arrow), spleen metastasis shrank obviously after 2 mo of pembrolizumab; O: right adrenal gland metastasis progressed gradually after 4.5 mo of pembrolizumab (orange arrow), spleen metastasis still shrank obviously after 4.5 mo of pembrolizumab; P: Right adrenal gland metastasis progressed rapidly after 8 mo of pembrolizumab, spleen metastasis was still well controlled after 8 mo of pembrolizumab.