A Peculiar Adenocarcinoma

Abstract

A man in his 60s presented with a 1-year history of a mild, dry cough. He was otherwise asymptomatic and had no physical limitations. He had never smoked, and results of his physical examination were normal. Results of complete blood cell counts, basic metabolic panel, and liver function tests were all within normal limits. A chest radiograph revealed a 10 × 9-cm lobulated left lower lobe mass. Examination of a biopsy specimen showed a primary adenocarcinoma with an immunohistochemical profile of CDX2 positive, CK20 positive, TTF-1 negative, and napsin A negative. His EGFR (OMIM 131550), ALK (OMIM 105590), and ROS1 (OMIM 165020) genes were wild type, and results of testing for programmed cell death protein 1 (PD-1) and programmed death ligand 1 (PD-L1) were 0%. Results of upper gastrointestinal tract endoscopy and colonoscopy did not reveal any evidence of a primary malignant neoplasm. Positron emission tomography showed no evidence of mediastinal lymphadenopathy or extrathoracic disease. Given the patient's excellent performance status, he underwent a mediastinoscopy with left lower lobe lobectomy. Results of postoperative pathologic testing showed a 13-cm adenocarcinoma with similar immunohistochemical markers as in the prior biopsy specimen. Surgical margins were negative for involvement, with no large vessel or perineural invasion seen. Five sampled lymph nodes were negative for involvement. Repeat pathologic interpretation was performed (Figure).

Clinical features and prognosis of pulmonary enteric adenocarcinoma: A retrospective study in China and the SEER database

“…( 16 ). The most prevalent distant metastatic sites in patients with advanced stages were lung, bone, liver, distant lymph nodes, and adrenal metastases ( 6 , 20 ), whereas skin and pancreatic metastases were rare ( 21 , 22 ). Feng et al.…”

“…Patel et al. ( 20 ) covered a 60-year-old male patient treated with docetaxel + cisplatin after surgery. Six months later, the disease relapsed, then he received nivolumab, which remained effective for more than 14 months.…”

“…The main chemotherapy regimens were pemetrexed + platinum (cisplatin or carboplatin) and paclitaxel + cisplatin, and the disease was controlled in all cases (efficacy evaluated as PR/stable disease (SD)). Patel et al (20) covered a 60-year-old male patient treated with docetaxel + cisplatin after surgery. Six months later, the disease relapsed, then he received nivolumab, which remained effective for more than 14 months.…”

“…While 19 earlystage (stage I and II) patients and 9 stage III-IV patients were among the 28 patients with PEAC investigated by Zhao et al(16). The most prevalent distant metastatic sites in patients with advanced stages were lung, bone, liver, distant lymph nodes, and adrenal metastases(6,20), whereas skin and pancreatic metastases were rare(21, 22).Feng et al (15) enrolled three patients (30%) in stages I and II and 27 (90%) in stages III-IV of the 30 patients included. Chen et al (19) found 12 patients (67%) in early-stage (stage I-II) and 6 (90%) in stages III-IV of the 18 patients with PEAC.…”

Cancer survivors’ limitations in functional abilities are increasing

“…These are among the key findings of a recent study published as a research letter in JAMA Oncology that examined trends in functional limitations among US cancer survivors between 1999 and 2018 1 . The study builds on data from a prior study showing that 70% of cancer survivors in 2018 reported some functional limitation—a rate nearly twice that of the general population 2 …”