A pulmonary enteric adenocarcinoma patient harboring a rare EGFR exon 19 P753S mutation: Case report and review

Abstract

Pulmonary enteric adenocarcinoma (PEAC) is a rare subtype of non–small cell lung cancer (NSCLC), accounting for about 0.6% of all primary lung adenocarcinoma. Although epidermal growth factor receptor (EGFR) mutation is common in primary lung adenocarcinoma, it is rarely reported in PEAC. This case report describes a PEAC patient with co-mutations of EGFR, Kirsten rat sarcoma viral oncogene (KRAS), and TP53, being treated with immunotherapy combined with chemotherapy. A 69-year-old man complained of cough and expectoration with bloody sputum for 2 weeks. The lung-enhanced CT scan showed a massive soft tissue shadow, about 46 × 35 mm in the lower lobe of the right lung. The neoplasm sample in the lower lobe of the right lung was obtained using CT-guided fine-needle aspiration (FNA). Immunohistochemical assays showed that the tumor was positive for CK7, CDX-2, C-MET, and villin. Gastroscopy and rectal colonoscopy had been performed respectively to exclude a diagnosis of colorectal adenocarcinoma. The patient was finally diagnosed with pulmonary intestinal adenocarcinoma. Next-generation sequencing (NGS) analysis showed a rare EGFR exon 19 missense mutation (c.2257C>T, p.P753S), KRAS exon 2 missense mutation (c.35G>T, p.G12V), and TP53 exon 5 missense mutation (c.401T>C, p.F134S). The lung-enhanced CT scan showed that the tumor shrank after four cycles of chemotherapy combined with immunotherapy. We hope that this case report can increase the understanding of this rare type of tumor and provide new molecular indications for diagnosis and individualized treatment. Furthermore, the combination of chemotherapy and immunotherapy seems to be an effective therapy for PEAC. Whether the use of immunotherapy can provide clinical benefits needs to be further explored with more samples in future studies.

Lymph node and bone metastasis of pulmonary intestinal adenocarcinoma: A case report

“…The onset of PEAC is usually insidious and most patients have no specific clinical symptoms, which makes it difficult for patients to receive an early diagnosis and treatment; the condition has usually been developing for a period of time when admitted to the hospital, which may relate to the fact that PEAC mostly manifests as peripheral lung cancer that mostly originates from small bronchi and grows slowly (17)(18)(19). Zhao et al (20) summarized the clinical symptoms of 28 patients with primary PEAC.…”

A graphSAGE discovers synergistic combinations of Gefitinib, paclitaxel, and Icotinib for Lung adenocarcinoma management by targeting human genes and proteins: the RAIN protocol

“…Aumolertinib operates by inhibiting the activity of EGFR whose aberration causes cancers. [195][196][197][198][199][200][201] Savolitinib, designed as a small molecule inhibitor targeting the tyrosine kinase of the mesenchymal epithelial transition factor (MET), is mainly intended for treating non-small cell lung cancer (NSCLC) associated with MET mutations. Functioning as a MET tyrosine kinase inhibitor with high specificity, it exhibits promise in treating various cancers, such as NSCLC, breast, head and neck, colorectal, gastric, pancreatic, and other gastrointestinal cancers.…”

Bilateral Pulmonary Enteric Adenocarcinoma on FDG PET/CT

“…The combination of pathological examination with immunohistochemical staining from the biopsied specimen and imaging result from FDG PET/CT lead to a diagnosis of pulmonary enteric adenocarcinoma. Pulmonary enteric adenocarcinoma is a rare subtype of primary invasive lung adenocarcinoma 2–5 that occurs in approximately 0.6% of pulmonary adenocarcinomas. The diagnosis of pulmonary enteric adenocarcinoma is challenging due to the similarity of histological and immunohistochemical morphology to lung metastasis from colorectal cancer 6,7 .…”