Case Report Invasive Mucinous Adenocarcinoma of the Lung çä¾ ...

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H. T. Liu et al./JCRP 28(2012) 94-98 97 A B Figure 4. (A) Series of chest films show initial response to a course of chemotherapy with paclitaxel and cisplatin, and (B) progressive disease two months later express CDX2, which was previously thought to be a specific marker for tumors with intestinal differentiation. Due to the introduction of the new classification system and rare disease incidence rate, there were lim-
98 H. T. Liu et al./JCRP 28(2012) 94-98 ited studies that had mentioned the treatment of invasive mucinous adenocarcinoma. According to WHO 2004 classification, research has shown that surgery for resectable disease remains the mainstay treatment of BAC [4]. However, for invasive mucinous adenocarcinoma, there was no study which demonstrated an optimum treatment response. Some reports showed a good treatment response to tyrosine kinase inhibitor (TKI) in MIA patients harboring the EGFR mutation [5,6]. However, the EGFR mutation represents a relatively low percentage of total cases in comparison with other types of adenocarcinoma. For this patient, comprehensive studies had been done to exclude various metastatic origins. Ultimately, she was diagnosed with stage IV primary lung cancer. Because of the wild type EGFR sequencing, we chose paclitaxel (175 mg/m 2 ) plus cisplatin (50 mg/m 2 ) (TC) as first line chemotherapy. Although the patient’s initial response to this course of treatment was good, her disease progressed after three cycles of TC regimen (Figure 4). The clinical course implied that the disease had aggressive behavior, which often leads to a poor prognosis as occurred in this case. The valuable information we obtained from this case was that invasive mucinous adenocarcinoma can have unusual presentation and distinct pathological features, highlighting the importance of multidisciplinary cooperation for accurate diagnosis and treatment. Although we have found no strong evidence of a particularly efficacious, long-term treatment, we suggest paclitaxel plus cisplatin as an option for the first line chemotherapy. REFERENCES 1. Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6: 244-285, 2011. 2. Morency E, Rodriguez Urrego PA, Szporn AH, et al. The “drunken honeycomb” feature of pulmonary mucinous adenocarcinoma: a diagnostic pitfall of bronchial brushing cytology. Diagn Cytopathol: n/a–n/a, 2011. 3. Mazziotta RM, Borczuk AC, Powell CA, et al. CDX2 immunostaining as a gastrointestinal marker: expression in lung carcinomas is a potential pitfall. Appl Immunohistochem Mol Morphol 13: 55-60, 2005. 4. Whitson BA, Groth SS, Andrade RS, et al. Invasive adenocarcinoma with bronchoalveolar features: a population-based evaluation of the extent of resection in bronchoalveolar cell carcinoma. J Thorac Cardiovasc Surg 143(3):591-600,2012 . 5. Kitazaki T, Fukuda M, Kohno S, et al. Novel effects of gefitinib on mucin production in bronchioloalvelar carcinoma; two case reports. Lung Cancer 49(1):125-8, 2005. 6. Popat N, Raghavan N, McIvor RA. Severe bronchorrhea in a patient with bronchioloalveolar carcinoma. CHEST 141(2): 513-514, 2012.
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