Targeted sequencing may facilitate differential diagnostics of pulmonary tumours: a case series

Abstract

BackgroundHistopathological diagnosis is important for prognostication and choice of treatment in patients with cancer in the lung. Metastases to the lungs are common and need to be distinguished from primary lung cancer. Furthermore, cases with synchronous or metachronous primary lung cancers (although infrequent) are often handled differently than cases with lung cancer with intrapulmonary metastasis or relapse, respectively. In some cases, morphology and immunohistochemical staining is not sufficient for certain diagnosis.MethodsThe present study included six cases where molecular genetic analysis in form of pyrosequencing or targeted next-generation sequencing was of value for certain diagnosis of selected tumours in the lung.ResultsTwo of the included cases were rare metastases to the lung; colorectal cancer with IHC profile consistent with primary lung cancer and malignant adenomyoepithelioma of the breast, respectively, where molecular genetic analysis was of aid for proving the relationship to the primary tumour. The other four cases were multiple lung adenocarcinomas where molecular genetic analysis was of aid to distinguish between intrapulmonary metastasis and synchronous tumour.ConclusionsComparison of molecular genetic profile may be an important tool for determination of relationship between tumours in some situations and should always be considered in unclear cases. Further studies on concordance and discordance of molecular genetic profiles between spatially or temporally different tumours with common origin may be helpful for improved diagnostics of pulmonary tumours.

Successful therapy using high-dose furmonertinib for non-small cell lung cancer with leptomeningeal metastasis: a case report and literature review

“…The ORR for extracranial lesions in patients with CNS metastases treated with furmonertinib has been found to be 77% ( 26 ), exceeding the ORRs of 56% in patients treated with osimertinib ( 27 ) and 61.5% in patients treated with aumolertinib ( 35 ). A case series in NSCLC has reported that ineffective TKI treatment could be explained in part by the discordance of molecular genetic profiles in lung adenocarcinoma with intrapulmonary metastases ( 36 ). We considered the possibility that extracranial resistance to furmonertinib could be attributed to the coexistence of the T790M mutation with other subclones.…”

Genomic and Clinical Significance of Multiple Primary Lung Cancers as Determined by Next-Generation Sequencing

“…30 NGS is now emerging as a potential tool for determining clonality of tumor in clinical care, in which routine investigation and older mutational profiling techniques prove inconclusive. Ericson-Lindquist et al 31 reported a recent series of six cases in which pyrosequencing or NGS was used to determine clonality to other lung cancers or distant primaries.…”