直肠转移是EGFR L858R突变的原发性肺腺癌的最初表现:1例报告

IF 2.5 3区 医学 Q3 ONCOLOGY
Rui Nian, Mengzhu Wang, Juanyi Wang, Xiang Li, Jianjun Li, Ling Lin, Shushen Ji, Huihui Jiang, Wanjun Li
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引用次数: 0

摘要

背景:非小细胞肺癌(NSCLC)约占所有肺癌的80%,40%的肺癌患者在诊断时存在远处转移。原发性肺腺癌在出现肺部症状前出现有症状的直肠转移是极为罕见的。这是首次报道一例罕见的EGFR l858r突变原发性肺腺癌直肠转移病例。病例介绍:一名79岁男性因便秘加重而就诊。结肠镜检查显示直肠肿块,但最初的活检仅显示慢性直肠粘膜炎症。患者接受了刺激排便的对症治疗,但便秘症状加重。当症状发展为呼吸困难、咳嗽、咳痰、双侧下肢无力和食欲不振时,影像学显示右上肺叶顶端段有边界不清的混合性磨玻璃结节。影像学显示直肠中下段壁增厚,直肠周围有多个小淋巴结。直肠穿刺活检标本和腹腔镜腹膜活检切除的白色结节免疫组化一致显示CK7(+)、TTF-1(+)、Napsin A(+)、CK20(-)、CDX2(-)染色,证实原发性肺腺癌直肠转移。腹腔镜结肠横造口术后,患者开始使用靶向EGFR L858R突变的甲磺酸奥莫替尼片治疗,并对直肠转移灶进行姑息性放疗。结论:虽然原发性肺腺癌直肠转移携带EGFR L858R突变极为罕见,但临床医生应降低肺部低剂量螺旋CT的阈值。此外,免疫组织化学结合分子诊断的组织病理学分析对于及时准确诊断和区分直肠转移与原发性直肠恶性肿瘤至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rectal metastasis as the initial presentation of primary lung adenocarcinoma with an EGFR L858R mutation: a case report.

Background: Non-small cell lung cancer (NSCLC) accounts for approximately 80% of all Lung cancers, and 40% of patients with lung cancer present with distant metastases at diagnosis. Symptomatic rectal metastasis from primary lung adenocarcinoma before the onset of lung symptoms is exceedingly rare. This is the first report to describe an uncommon case of rectal metastasis from an EGFR L858R-mutant primary lung adenocarcinoma.

Case presentation: A 79-year-old male presented to the hospital for worsening constipation. Colonoscopy revealed a rectal mass, but initial biopsies revealed only chronic rectal mucosal inflammation. The patient received symptomatic treatment to stimulate defecation, but his symptoms of constipation worsened. As symptoms progressed to dyspnoea, cough, expectoration, bilateral lower limb weakness, and poor appetite, imaging revealed a mixed ground-glass nodule with poorly defined margins in the apical segment of the right upper lobe. Imaging also revealed thickening of the rectal wall in the mid-to-lower segments with multiple small perirectal lymph nodes. Immunohistochemical analysis of both the rectal puncture biopsy specimen and the white nodules resected during the laparoscopic peritoneal biopsy consistently revealed CK7 (+), TTF-1 (+), Napsin A (+), CK20 (-), and CDX2 (-) staining, which confirmed rectal metastasis from primary lung adenocarcinoma. After the laparoscopic transverse colostomy was performed, the patient began treatment with aumolertinib mesilate tablets that target the EGFR L858R mutation and received palliative radiotherapy for the rectal metastatic lesion.

Conclusions: Although rectal metastasis harbouring EGFR L858R mutations from primary lung adenocarcinoma is extremely rare, clinicians should have a low threshold for pulmonary low-dose spiral CT. In addition, histopathologic analysis by immunohistochemistry combined with molecular diagnostics is critical for a timely and accurate diagnosis and to distinguish rectal metastases from primary rectal malignancies.

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来源期刊
CiteScore
4.70
自引率
15.60%
发文量
362
审稿时长
3 months
期刊介绍: World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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