Figure 1.

Preoperative and pre-chemotherapy PET-CT scan. (A–D) shows a PET-CT scan performed in October 2019, evidencing a bulky expansive lesion occupying the large part of mediastinum and dislocating the right lung peripherally. Note thick red arrows pointing to a calcified necrotic center, englobed in the neoplatic mass. Thereafter, an induction chemotherapy was performed with the aim of reducing the mass and leading the patient to the surgical excision. Image in (E) shows a post-surgical CT scan performed in April 2020, during outpatient clinic follow up, note that the abdomen window was free from disease. However, an early relapse occurred in August 2020 with development of hepatic metastases (F). A first line of therapy SMT-oriented, with a sequential use of Nivolumab and Ipilimumab was used. However, after four months of therapy, a restaging with a CT scan was performed highlighting a progressive disease. The disease spread in the lung bilaterally (G) and in the abdomen (H) with a disease extension of the II and III hepatic segments over the epigastrium (thin red arrows).