Usefulness of Quantification and Serial Monitoring of Fine Crackles for Early Detection of Treatment-related Lung Injury: A Report of Two Cases.

Early detection and appropriate management of treatment-related interstitial lung disease (ILD) are important in cancer treatment. We established an algorithm for quantifying fine crackles using machine learning and reported that the fine crackle quantitative value (FCQV) calculated by this algorithm was more sensitive than chest radiography for detecting interstitial changes. Using this algorithm, we periodically analyzed respiratory sounds in two patients with lung cancer who developed treatment-related ILDs and found that the FCQV was elevated before the diagnosis of ILD. These cases may indicate the usefulness of the FCQV in the early diagnosis of treatment-related ILDs.

Concurrent lung adenocarcinoma hidden among multiple shadows of COVID-19 pneumonia: A rare and instructive case report.

A 40-year-old man was admitted with a diagnosis of COVID-19 pneumonia. Although most of multiple ground-glass opacities and consolidations on computed tomography improved, a round ground-glass opacity with consolidation remained unchanged and was suspected to be a part-solid nodule of lung adenocarcinoma. Pathologic diagnosis of resected tumor was papillary adenocarcinoma.

Pulmonary pleomorphic carcinoma in an elderly patient treated with pembrolizumab shows a marked response.

Pulmonary pleomorphic carcinoma, a relatively rare histopathological subtype of non-small cell lung cancer, is a malignant neoplasm with a poor prognosis. Despite the reports of a good response to immune-checkpoint inhibitor, only a few reports of pembrolizumab as the first-line treatment exist. We report the case of a 78-year-old male with right lung mass, mediastinal, right neck, and supraclavicular lymphadenopathies. He was diagnosed with pulmonary pleomorphic carcinoma, cT4N3M1c, Stage IVB. The tumor cells showed high programmed death-ligand 1 (PD-L1) expression but no microsatellite instability. After three cycles of pembrolizumab as the first-line therapy, chest computed tomography revealed marked reduction in tumor diameter. No remarkable adverse events occurred. The patient is alive with no complaints and no disease progression and has continued pembrolizumab for 8 months. Thus, first-line pembrolizumab therapy appears beneficial against pulmonary pleomorphic carcinoma, at least when PD-L1 expression is high. It is also effective in elderly patients.

First-line immune checkpoint therapy in metastatic squamous cell lung cancer harboring both EGFR mutation and high expression of PD-L1: A case report.

A 90-year-old female was admitted to our hospital with a history of a dry cough. Chest computed tomography (CT) scan showed a tumor shadow, and CT-guided lung biopsy revealed squamous cell carcinoma harboring an EGFR mutation. In addition, programmed death-ligand 1 (PD-L1) was highly expressed with a tumor proportion score (TPS) of >75%. Pembrolizumab therapy in the first-line setting was not effective, and the patient died at six months from the first visit. Squamous cell lung cancers (SCLCs) with both EGFR mutation and high expression of PD-L1 are very rare.