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Vol.64 No.1 contents | Japanese/English |
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- Case Report -
A Case of ROS1 Fusion Gene-positive Lung Adenocarcinoma Diagnosed After Pulmonary Thromboembolism
Yukako Miyahira1, Toshiyuki Sumi2,3, Keito Suzuki2,3, Yuta Koshino2,3, Takumi Ikeda2,3, Hiroki Watanabe2, Yuichi Yamada2, Hirofumi Chiba31Junior resident, 2Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Japan, 3Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Japan
Background. ROS1 fusion gene-positive lung cancer is a rare genetic mutation that accounts for 1-2% of non-small-cell lung cancer (NSCLC) cases. ROS1-positive lung cancer is more common in younger patients, women, nonsmokers, and pathological adenocarcinoma with mucus than in others. NSCLC is associated with an increased incidence of thromboembolism, and NSCLC with ROS1 fusion gene mutations is associated with an elevated risk of thrombosis. We encountered a patient diagnosed with ROS1-positive lung adenocarcinoma after pulmonary thromboembolism. Case. A 46-year-old man visited our hospital with shortness of breath and pain in both lower legs. Contrast-enhanced computed tomography (CT) revealed a thrombus in the pulmonary artery and left femoral vein, nodular shadow in the right middle lobe, and mediastinal lymphadenopathy. The patient was admitted to the hospital and diagnosed with pulmonary thromboembolism based on CT findings. Continuous heparin injections were administered immediately. We diagnosed the patient with ROS1-positive lung adenocarcinoma cStage IVA after performing endoscopic ultrasound with bronchoscopy-guided fine-needle aspiration from a mediastinal lymph node. We switched the patient from continuous heparin injection to apixaban and started additional treatment with crizotinib. After three months, the thrombus resolved, and the primary tumor and lymph nodes shrank. Thrombus resolution and tumor shrinkage persisted for over 12 months. Conclusions. Patients with NSCLC and thrombotic events should be promptly scrutinized and anticoagulated, considering the possibility of rare genetic mutations.
key words: Pulmonary thromboembolism, ROS1 fusion gene, Lung adenocarcinoma, EUS-B-FNA, Crizotinib
Received: August 3, 2023
Accepted: October 2, 2023
JJLC 64 (1): 28-33, 2024
