Umhlaza wemiphunga weeseli ezincinci ezisasazekayo-01

NgoJuni 2022, isigulana esiyindoda esineminyaka engama-65 ubudala sahlolwa rhoqo, kwaye i-CT scan yabonisa iqhuqhuva phantsi kwe-pleura kwi-lobe ephezulu yasekunene yomphunga. NgoJanuwari 2023, isigulana saqala ukuba neempawu ezifana nokurhawuzelela, ukukhwehlela, kunye nokuphefumla kancinci. NgoMeyi 2023, ukukhwehlela kwaso kunye nokuphefumla kancinci kwakuye kwaba mandundu. Iiskeni zabonisa ukwanda okukhulu komsebenzi we-metabolic kwi-lobe ephezulu yasekunene yomphunga, nto leyo ebonisa kakhulu umhlaza wemiphunga. Ukongeza, ukwanda komsebenzi we-metabolic kwabonwa kwiindawo ezininzi ze-lymph nodes, kubandakanya indawo yasekunene ye-supraclavicular, i-mediastinum, i-trachea, indawo ye-para-aortic, kunye ne-inferior vena cava. Imifanekiso ikwabonise ukuqina kwamaqhuqhuva amaninzi kwi-pleura yasekunene kunye nomsebenzi we-metabolic owandisiweyo. Iziphumo zovavanyo zabonisa ukusasazeka kwe-pleural yasekunene kunye ne-pleural effusion, kwaye ukuxilongwa kokugqibela komhlaza wemiphunga weeseli ezincinci ezisasazekayo kwaqinisekiswa ngovavanyo lwe-pathological, i-imaging, kunye ne-immunohistochemistry. Isigulana safumana unyango ngokukhutheleyo.

Emva kweenyanga ezintlanu, umthamo wethumba wawunciphile kakhulu, kwaye uninzi lwezilonda ezisasazekileyo zanyamalala. Inkqubo yonyango yayiquka unyango lokuqala lwe-atezolizumab immunotherapy oludityaniswe nonyango olujoliswe kwi-anlotinib. I-Atezolizumab yanikwa idosi ye-1200 mg ngosuku lokuqala, yalandelwa kukumiswa kancinci kunyango. I-Anlotinib yanikwa ngomlomo idosi ye-10 mg imihla ngemihla kangangeeveki ezimbini ezilandelelanayo, yalandelwa lixesha lokuphumla leentsuku ezisixhenxe, yakha umjikelo wonyango weentsuku ezingama-21. Emva kweeseshoni ezili-15 zonyango ngemitha, imifanekiso ye-CT yabonisa ukwehla okukhulu kwesilonda kumphunga wasekunene, kwaye i-mediastinum yasekunene kunye ne-lymph nodes nazo zehlile kakhulu. I-CT scan elandelayo ngoSeptemba 10, 2023, yabonisa utshintsho oluhle: ukuncipha kokuphuma kwe-pleural yasekunene, ukuncipha kokuqina kwe-pleural yasekunene, kunye ne-mediastinal kunye ne-supraclavicular lymph nodes ezincinci, ngaphandle kokwandiswa kwe-lymph nodes zesisu kunye ne-retroperitoneal.

Xa kuthelekiswa neskeni eyenziwe ngoMeyi 7, 2023, iskeni eyenziwe ngo-Okthobha 10, 2023, ibonise ukwehla okukhulu kwethumba. Ngokukodwa, ukushwabana kwabonwa kwi-nodule kwi-lobe ephezulu yasekunene nakwii-lymph nodes ezininzi kufutshane ne-trachea, imithambo yegazi, indawo ye-para-aortic, kunye ne-inferior vena cava. Ukuqina kwe-nodular okubonwe ngaphambili kwi-peritoneum yendawo, udonga lwesifuba sasekunene, kunye nesithuba se-11th-12th intercostal kuye kwehla kakhulu. Ukongeza, isithunzi se-nodular esincinci kancinci kwimisipha yehlombe lasekunene naso siye kwehla kakhulu. Ezi ziphumo zibonisa ukuba inkqubo yonyango lwenkqubo yayisebenza, uninzi lwezilonda ezisasazekayo ziyanyamalala kwaye ezinye izilonda ziyancipha kakhulu. Uvavanyo lomfanekiso lubonisa ukuba inkqubo yonyango iphumelele, kwaye ithumba ngoku likwinqanaba lokuxolelwa okuncinci.