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. 2020 Dec 23;10:615298. doi: 10.3389/fonc.2020.615298

Figure 2.

Figure 2

(A) H&E stain from lymph node metastasis (10X magnification). (B) F18-FDG PET/CT Coronal MIP projection obtained prior to initiation of immunotherapy. The yellow arrow indicates the dominant lesion, while the yellow arrowheads indicate additional nontarget and/or suspicious lesions. (C) PD-L1 stain showing strong membranous staining in the tumor cells (10X magnification). Follow-up PET/CT (D) approximately 3 months after initiation of immunotherapy reveals resolution or near resolution of the nontarget lesions with decrease in dominant lesion. There is new focus of radiotracer accumulation in the right hilum, which is of unclear clinical significance (red arrowhead). The six months follow-up PET/CT (E) reveals grossly symmetric FDG avid hilar regions (red arrowheads) suggesting possible development of sarcoidosis of sarcoid-like reaction, an uncommon but reported finding in immunotherapy (27). There has been interval enlargement of the dominant lesion and re-emergence of some suspicious lymph nodes (yellow arrow and arrowhead).