Cargando…

Targeted Sequencing Facilitated Diagnosis of an Uncommon Patient Harboring Both Multiple Primary and Intrapulmonary Metastatic Lung Cancer: A Case Report

Estimated to comprise approximately 10% of lung cancer cases, multiple pulmonary lesions pose a diagnostic and therapeutic challenge in thoracic oncology. Distinction between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) directly affects tumor staging and clinical managemen...

Descripción completa

Detalles Bibliográficos
Autores principales: Li, Hefei, Dong, Shaoyong, Zhang, Duo, Guo, Zhimin, Li, Ce, Xiang, Jianxing, Zou, Xiao, Yan, Li, Sun, Ying, Li, Wei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165299/
https://www.ncbi.nlm.nih.gov/pubmed/34079290
http://dx.doi.org/10.2147/OTT.S309155
_version_ 1783701289939501056
author Li, Hefei
Dong, Shaoyong
Zhang, Duo
Guo, Zhimin
Li, Ce
Xiang, Jianxing
Zou, Xiao
Yan, Li
Sun, Ying
Li, Wei
author_facet Li, Hefei
Dong, Shaoyong
Zhang, Duo
Guo, Zhimin
Li, Ce
Xiang, Jianxing
Zou, Xiao
Yan, Li
Sun, Ying
Li, Wei
author_sort Li, Hefei
collection PubMed
description Estimated to comprise approximately 10% of lung cancer cases, multiple pulmonary lesions pose a diagnostic and therapeutic challenge in thoracic oncology. Distinction between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) directly affects tumor staging and clinical management. In equivocal cases in which the lesions are histopathologically indistinguishable, targeted sequencing can provide key additional evidence for differential diagnosis. Herein, we describe an unusual patient who presented with seven lung lesions that consisted of primary tumors and metastatic lesions, each showing distinct clonality status based on histomolecular findings. Specifically, the 45-year-old female never-smoker underwent a surgery that removed one invasive lepidic predominant adenocarcinoma and five microinvasive adenocarcinomas. Next-generation sequencing revealed three of the lesions to carry a clonal driver mutation EGFR p.L858R, supporting an IMP diagnosis. EGFR p.L858R was not detected in two other surgical specimens, which instead harbored respective oncogenic BRAF p.G469A and an uncommon EGFR p.G779F. These results led to diagnosis of the two lesions as primary tumors of lineages different from that of the metastases. The patient had achieved a recurrence-free survival of 21 months as of the latest follow-up. In this rare case that presented with evidence of both MPLC and IPM, targeted sequencing proved valuable in facilitating the diagnostic workup.
format Online
Article
Text
id pubmed-8165299
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Dove
record_format MEDLINE/PubMed
spelling pubmed-81652992021-06-01 Targeted Sequencing Facilitated Diagnosis of an Uncommon Patient Harboring Both Multiple Primary and Intrapulmonary Metastatic Lung Cancer: A Case Report Li, Hefei Dong, Shaoyong Zhang, Duo Guo, Zhimin Li, Ce Xiang, Jianxing Zou, Xiao Yan, Li Sun, Ying Li, Wei Onco Targets Ther Case Report Estimated to comprise approximately 10% of lung cancer cases, multiple pulmonary lesions pose a diagnostic and therapeutic challenge in thoracic oncology. Distinction between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) directly affects tumor staging and clinical management. In equivocal cases in which the lesions are histopathologically indistinguishable, targeted sequencing can provide key additional evidence for differential diagnosis. Herein, we describe an unusual patient who presented with seven lung lesions that consisted of primary tumors and metastatic lesions, each showing distinct clonality status based on histomolecular findings. Specifically, the 45-year-old female never-smoker underwent a surgery that removed one invasive lepidic predominant adenocarcinoma and five microinvasive adenocarcinomas. Next-generation sequencing revealed three of the lesions to carry a clonal driver mutation EGFR p.L858R, supporting an IMP diagnosis. EGFR p.L858R was not detected in two other surgical specimens, which instead harbored respective oncogenic BRAF p.G469A and an uncommon EGFR p.G779F. These results led to diagnosis of the two lesions as primary tumors of lineages different from that of the metastases. The patient had achieved a recurrence-free survival of 21 months as of the latest follow-up. In this rare case that presented with evidence of both MPLC and IPM, targeted sequencing proved valuable in facilitating the diagnostic workup. Dove 2021-05-26 /pmc/articles/PMC8165299/ /pubmed/34079290 http://dx.doi.org/10.2147/OTT.S309155 Text en © 2021 Li et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Case Report
Li, Hefei
Dong, Shaoyong
Zhang, Duo
Guo, Zhimin
Li, Ce
Xiang, Jianxing
Zou, Xiao
Yan, Li
Sun, Ying
Li, Wei
Targeted Sequencing Facilitated Diagnosis of an Uncommon Patient Harboring Both Multiple Primary and Intrapulmonary Metastatic Lung Cancer: A Case Report
title Targeted Sequencing Facilitated Diagnosis of an Uncommon Patient Harboring Both Multiple Primary and Intrapulmonary Metastatic Lung Cancer: A Case Report
title_full Targeted Sequencing Facilitated Diagnosis of an Uncommon Patient Harboring Both Multiple Primary and Intrapulmonary Metastatic Lung Cancer: A Case Report
title_fullStr Targeted Sequencing Facilitated Diagnosis of an Uncommon Patient Harboring Both Multiple Primary and Intrapulmonary Metastatic Lung Cancer: A Case Report
title_full_unstemmed Targeted Sequencing Facilitated Diagnosis of an Uncommon Patient Harboring Both Multiple Primary and Intrapulmonary Metastatic Lung Cancer: A Case Report
title_short Targeted Sequencing Facilitated Diagnosis of an Uncommon Patient Harboring Both Multiple Primary and Intrapulmonary Metastatic Lung Cancer: A Case Report
title_sort targeted sequencing facilitated diagnosis of an uncommon patient harboring both multiple primary and intrapulmonary metastatic lung cancer: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165299/
https://www.ncbi.nlm.nih.gov/pubmed/34079290
http://dx.doi.org/10.2147/OTT.S309155
work_keys_str_mv AT lihefei targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT dongshaoyong targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT zhangduo targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT guozhimin targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT lice targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT xiangjianxing targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT zouxiao targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT yanli targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT sunying targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport
AT liwei targetedsequencingfacilitateddiagnosisofanuncommonpatientharboringbothmultipleprimaryandintrapulmonarymetastaticlungcanceracasereport