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Vol.64 No.1 contents | Japanese/English |
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- Case Report -
An Autopsy of a Patient with Strongly PD-L1-positive SMARCA4-deficient Large Cell Lung Cancer Treated with Pembrolizumab Who Died of Hyperprogressive Disease
Mai Imao1, Yuya Tanaka1, Miki Ikeuchi1, Hiroki Yamamoto1, Sachie Kume1, Takashi Inao1, Kazuya Monden1, Kojiro Otsuka1, Chiho Obayashi2, Yujiro Suzuki11Respiratory Center, 2Department of Pathology, Shinko Hospital, Japan
Background. Thoracic SMARCA4-deficient undifferentiated tumors have been newly classified in the World Health Organization's fifth edition classification of thoracic cancers and have attracted much attention. Notably, SMARCA4 deficiency occurs in 10% of non-small cell lung cancers (NSCLC); however, its clinical significance has not been elucidated. Case. An 87-year-old man was referred to our hospital for suspected lung cancer in the right lower lobe, based on the computed tomography (CT) scan results. He was diagnosed with SMARCA4-deficient NSCLC (cT2aN3M1c, stage IVB) which was strongly positive for PD-L1; he was started on pembrolizumab. However, he developed respiratory failure and died on the 15th day of treatment. Chest and abdominal CT performed on the 13th day of treatment showed growth of the primary cancer, bilateral pleural effusion, and thickening of the broad interstitium, suggesting lymphangitic spread. Based on a pathological examination at autopsy, he was diagnosed with SMARCA4-deficient large cell lung cancer (yaT4N3M1c, stage IVB). He had advanced lymph node metastasis, and a microscopic examination revealed lymphatic invasion in the bilateral adrenal glands, thyroid, and intrapulmonary nodes. Conclusion. We conducted an autopsy of a patient with SMARCA4-deficient lung cancer who died of rapidly progressing disease after treatment using pembrolizumab, and a review of the relevant literature.
key words: SMARCA4-deficient non-small cell lung cancer, Large cell cancer, Autopsy, Immune checkpoint inhibitors, Hyperprogressive disease
Received: June 5, 2023
Accepted: September 28, 2023
JJLC 64 (1): 22-27, 2024
