Metastatic diki sero kenza yemapapu-01

Muna Chikumi 2022, murwere wechirume ane makore makumi matanhatu nemashanu akaongororwa muviri, uye CT scan yakaratidza nodule pazasi pepleura murudyi rwepamusoro lobe yemapapu. Muna Ndira 2023, murwere akatanga kuona zviratidzo zvakaita sekushomeka, kukosora, uye kupfupika kwekufema. Pakazosvika Chivabvu 2023, kukosora kwake uye kushomeka kwekufema kwakawedzera. Scans dzakaratidza zvakanyanya kuwedzera metabolic chiitiko mune yekurudyi yekumusoro lobe lung nodule, inokurudzira zvakanyanya kenza yemapapu. Uyezve, kuwedzera kwekuita kwemetabolism kwakaonekwa mumalymph nodes akawanda, kusanganisira iyo yakarurama supraclavicular region, mediastinum, trachea, para-aortic nzvimbo, uye yakaderera vena cava. Iyo mifananidzo yakaratidzawo akawanda nodular thickenings mune chaiyo pleura nekuwedzera metabolic chiitiko. Mhedzisiro yekuongorora yakaratidza kurudyi pleural metastasis ine pleural effusion, uye kuongororwa kwekupedzisira kwemetastatic diki kenza yemapapu yakasimbiswa kuburikidza nekuongororwa kwepathological, imaging, uye immunohistochemistry. Murwere akabva agamuchira kurapwa.

Mwedzi mishanu gare gare, vhoriyamu yebundu yakanga yadzikira zvakanyanya, uye maronda mazhinji emetastatic akange anyangarika. Mushonga wekurapa waisanganisira yekutanga atezolizumab immunotherapy yakasanganiswa neanlotinib yakanangwa kurapwa. Atezolizumab yaipihwa muyero we1200 mg pazuva rekutanga, ichiteverwa nekumbomira mukurapwa. Anlotinib yakapiwa nemuromo pachiyero che 10 mg zuva nezuva kwemavhiki maviri akatevedzana, inoteverwa nemazuva manomwe ekuzorora, achigadzira chirongwa chemazuva 21. Mushure mezvikamu gumi neshanu zveradiotherapy, CT mifananidzo yakaratidza kuderera kukuru kwechirwere mumapapu ekurudyi, uye iyo mediastinum yakarurama uye lymph nodes yakanga yadererawo zvakanyanya. Iyo yekutevera CT scan musi waGunyana 10, 2023, yakaratidza shanduko dzakanaka: kudzikisira kwekurudyi kwepleural effusion, kudzikira kwekurudyi kwepleural, uye madiki mediastinal uye ekurudyi supraclavicular lymph nodes, pasina kuwedzera kweabdominal uye retroperitoneal lymph nodes.

Zvichienzaniswa ne scan yaMay 7, 2023, scan yaGumiguru 10, 2023, yakaratidza kudzikiswa kwebundu. Kunyanya, shrinkage yakaonekwa mumutsara wekurudyi wepamusoro lobe uye mune dzakawanda lymph nodes pedyo ne trachea, mitsipa yeropa, para-aortic nzvimbo, uye inferior vena cava. Iyo yakambocherechedzwa nodular thickening munharaunda yemuno peritoneum, kurudyi anterior chest wall, uye 11th-12th intercostal nzvimbo yakanga yadzikira zvakanyanya. Pamusoro pezvo, iyo yakaderera-density nodular mumvuri mumhasuru yepfudzi yekurudyi yakanga yadzikirawo zvakanyanya. Mhedzisiro iyi inoratidza kuti chirongwa chekurapa chirongwa chaive chakashanda, uye maronda mazhinji emetastatic achinyangarika uye maronda akasara achiderera zvakanyanya. Ongororo dzekufungidzira dzinoratidza kuti chirongwa chekurapa chakabudirira, uye bundu ratove padanho rekuregererwa.