Salvage Lung Resection of Aspergilloma Mimicking Tumor Regrowth after Immune Checkpoint Inhibitor Therapy for Stage IV Squamous Cell Lung Cancer: A Case Report.

IF 0.7 Q4 SURGERY
Surgical Case Reports Pub Date : 2025-01-01 Epub Date: 2025-03-11 DOI:10.70352/scrj.cr.24-0096
Takahiro Utsumi, Haruaki Hino, Yuki Takeyasu, Natsumi Maru, Hiroshi Matsui, Yohei Taniguchi, Tomohito Saito, Takayasu Kurata, Koji Tsuta, Tomohiro Murakawa
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Abstract

Introduction: Recent advancements in chemotherapy, including immune checkpoint inhibitors, sometimes achieve complete remission in cases of stage IV lung cancer. On the other hand, immune-related adverse events may occur despite showing successful oncological effects. Herein, we report a rare case of a patient who underwent salvage lung resection after immune checkpoint inhibitor therapy for stage IVB lung cancer, which led to confirmed not only complete pathological remission but also complications with aspergilloma as a result of powerful effect for chemotherapy with immune checkpoint inhibitors.

Case presentation: A 71-year-old woman was diagnosed with stage IVB squamous cell carcinoma of the lung located in the right upper lobe, accompanied by distant organ metastases in the thoracic vertebrae and right adrenal gland. Because the tumor shrank after systemic cytotoxic chemotherapy plus immune checkpoint inhibitor therapy, a partial response was considered to have been achieved clinically, and chemotherapy was discontinued afterward. After 5 months, however, the primary lesion gradually regrew, and tumor regrowth was highly suspected. A bronchoscopic biopsy revealed Aspergillus organism infection other than lung cancer. As local recurrence could not be completely ruled out, salvage thoracoscopic right upper lobectomy with hilar lymph node dissection was performed uneventfully. The pathological diagnosis was pulmonary aspergilloma without residual cancer (pathological complete remission). After the surgery, an antifungal agent was administered for half a year and no obvious cancer recurrence or fungal relapse was detected over 1.5 years.

Conclusion: A salvage lung resection via thoracoscopic surgery was considered a feasible procedure. However, preoperative imaging does not always provide clear evidence of residual cancer, especially after chemotherapy with immune checkpoint inhibitors, as seen in the current patient. Therefore, salvage surgery should be considered comprehensively for selected patients with downstaged or relapsed lung cancer based on close image findings.

免疫检查点抑制剂治疗IV期鳞状细胞肺癌后模拟肿瘤再生的曲菌瘤抢救肺切除一例报告。
导论:化疗的最新进展,包括免疫检查点抑制剂,有时可以使IV期肺癌完全缓解。另一方面,尽管显示出成功的肿瘤效应,免疫相关的不良事件也可能发生。在此,我们报告了一例罕见的病例,患者在免疫检查点抑制剂治疗IVB期肺癌后进行了补救性肺切除术,结果证实不仅完全病理缓解,而且由于免疫检查点抑制剂化疗的强大作用,曲菌瘤并发症也出现了。病例介绍:一位71岁的女性被诊断为位于右上叶的IVB期肺鳞状细胞癌,并伴有胸椎和右肾上腺的远端器官转移。由于肿瘤在全身细胞毒性化疗加免疫检查点抑制剂治疗后缩小,临床上认为已经达到部分反应,随后停止化疗。但5个月后原发病灶逐渐再生,高度怀疑肿瘤再生。支气管镜活检显示曲霉菌感染而非肺癌。由于不能完全排除局部复发的可能性,我们顺利地进行了胸腔镜右上肺叶切除术和肺门淋巴结清扫术。病理诊断为肺曲菌瘤,无癌残留(病理完全缓解)。术后给予抗真菌药物治疗半年,1.5年内未发现明显的肿瘤复发或真菌复发。结论:胸腔镜下肺切除术是一种可行的手术方法。然而,术前成像并不总是提供残留癌症的明确证据,特别是在使用免疫检查点抑制剂化疗后,如本例患者所见。因此,对于晚期或复发肺癌患者,应根据近距离影像学表现综合考虑抢救手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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