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Vol.61 No.5 contents | Japanese/English |
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- Case Report -
Multiple Metastatic Lung Adenocarcinoma Diagnosed by the Detection of an EGFR Mutation: a Case Report
Ayaho Furukawa1, Naoto Takase1, Takashi Nishimura1, Mayuko Tokuda1, Tadanobu Hatsu1, Tadashi Okamoto1, Yoshihiro Hattori2, Yoshitane Tsukamoto3, Miyako Satouchi2, Nobuyuki Katakami11Department of Respiratory Medicine and Medical Oncology, Takarazuka City Hospital, Japan, 2Department of Thoracic Oncology, Hyogo Cancer Center, Japan, 3Department of Pathology, Takarazuka City Hospital, Japan
Background. In the current practice of chemotherapy, standard therapeutic regimens are predetermined by organ. Accordingly, identifying the primary focus in cases of carcinoma involving multiple metastases is essential. Case Report. A 61-year-old woman presented at a nearby hospital with macroscopic hematuria and weight loss. Computed tomography revealed a tumor in both kidneys and multiple neoplasms in both lungs. A biopsy of the kidney tumor suggested that the primary focus was located outside the kidneys, and the patient was referred to our hospital. As pulmonary lesions, a tumor with an infiltrative shadow in right S3 and multiple nodular shadows were observed. The lesions in S3 and S5 were biopsied. The S3 lesion showed TTF-1-positive lung adenocarcinoma findings. The S5 lesion was TTF-1-negative and showed no specific differentiation tendency. Immunostaining images were similar to those of kidney tumors. The EGFR gene mutations in the S3 tumor showed a deletion in exon 19. Both the S5 tumor and kidney tumor also showed a deletion in exon 19. The patient was diagnosed with EGFR gene mutation-positive pulmonary adenocarcinoma, multiple lung metastases, and metastasis to both kidneys. After treatment with afatinib was initiated, the tumors shrank. Conclusion. Although the clinical and pathological findings did not help identify the origin of the kidney tumors in this case, a genetic investigation was useful for diagnosing the patient with metastasis of EGFR-positive lung adenocarcinoma to both lungs. Our experience indicates the usefulness of genetic testing in identifying primary foci and determining therapeutic strategies.
key words: Lung cancer, Renal metastasis, EGFR mutation, Afatinib
Received: April 29, 2021
Accepted: June 10, 2021
JJLC 61 (5): 429-433, 2021
