INTRODUCTION

Lung cancer is the leading cause of cancer-related mortality worldwide with peak mortality rate occurring in patients aged 80 years and above. While NSCLC are often diagnosed at advanced stage when treatment options are few, access to treatment in elderly are even more limited due to treatment tolerability and potential toxicity. At present, Osimertinib is the first line treatment option for patients with metastatic NSCLC with EGFR mutations. Some adverse reactions are diarrhea, nausea, headaches, stomatitis, and rashes that lead to interruption or even stopping of the medication.

Here we present a case about an 89-year-old female with smoking history of 20 pack-years who initially presented at the emergency room with progressive shortness of breath. Chest radiograph showed right pleural effusion for which pigtail was inserted. Bronchoscopy revealed a completely obstructing mass at the right upper lobe. Her biopsy showed EGFR-mutated non-small cell lung adenocarcinoma. Patient underwent radiotherapy and was started on osimertinib 80mg daily. However, patient developed severe diarrhea for which her subsequent dosing was reduced to 40mg once daily. Repeat PET CT scan after 10 months showed significant reduction of the primary mass.

In patients with metastatic EGFR-mutated lung adenocarcinoma, Osimertinib proves to be an effective option and is associated with improved overall survival even on a low-dose. This dose reduction strategy may be an option especially for elderly patients with tolerability issues. Nonetheless, treatment choices should prioritize patients' functional status and comorbidities over age, underscoring the importance of personalized approaches despite chemotherapy's inherent risks.

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare type of kidney tumor that has only been recently described. Furthermore, a case of MTSCC associated with a simultaneous lung cancer in the same patient has never been reported in the literature. In this paper, we describe a kidney tumor that was detected during staging work-up in a 72-year-old lung cancer patient. The kidney tumor was removed and shown to exhibit histological and immunophenotypic features of MTSCC, completely distinct from the pulmonary adenocarcinoma. In addition, this case was unique because it was characterized by neuroendocrine differentiation as well as p53 and Ki-67 overexpression in tumor cells. Therefore, we report a case of MTSCC diagnosed in a patient with pulmonary adenocarcinoma and describe the detailed histologic and immunohistochemical features of MTSCC.
Adenocarcinoma ; Lung Neoplasms

No abstract available.
Adenocarcinoma, Mucinous* ; Lung* ; Mucins*

BACKGROUND: Tumor associated antigens, which are produced specifically by tumor cells, are promising targets for the early diagnosis and immunotherapy. Among the tumor associated antigens, MAGE (a melanoma antigen), BAGE, GAGE, PRAME and NY-ESO were named as cancer/testis specific antigens since they are detected exclusively in the testis or cancer cells. If MAGE is easily detectable in the sputum, it would become a convenient method for diagnosing lung cancer. This study was undertaken to investigate MAGE expression in the induced sputum obtained from lung cancer patients. METHOD: In 14 control patients and 30 lung cancer patients, the induced sputum was collected after inhaling 3% saline(5 cc) delivered by nebulizer for approximately 5 minutes after a mouth rinse and bronchodilator inhalation. The induced sputum was placed in a conservative-mixed solution (guanidinium isothiocyanate, Triton X-100). The total cellular mRNA was extracted from the cells and RT PCR and nested PCR were run in 30 and 35 cycles respectively, with two different types of primers specially designed to detect six subtypes of MAGE DNA simultaneously. RESULTS: MAGE expression was not detected in the 14 controls, but in the 30 cancer patients, MAGE was found in 24 patients (80%, p=0.001). In the cancer patients, there were no differences in the expression level according to the tissue types (squamous cell cancer 13/17, adenocarcinoma 7/9, and small cell cancer 4/4, p=0.56). Among the 24 MAGE-positive patients, the tumor was not visible on a bronchoscopy in 11 patients (45.8%). CONCLUSION: A study of MAGE in induced sputum appears to be a useful and complementary method in the diagnosis of lung cancer. A further prospective study with more patients is recommended.
Adenocarcinoma ; Lung Neoplasms

No abstract available.
Adenocarcinoma ; Erysipeloid ; Lung

Metastasis to the pituitary gland is an unusual situation in clinical practice and is typically observed in those with underlying malignancy with breast and lung being the commonest primary site. However, we report a case of an apparently well 49-year-old female with metastatic lung adenocarcinoma who presented with visual disturbance and diabetes insipidus related to pituitary metastasis as an initial presentation.
Diabetes Insipidus ; Adenocarcinoma of Lung

Primary enteric adenocarcinoma is a rare variant of primary pulmonary adenocarcinoma. This disease lacks a distinctive manifestation and often requires pathological examination to make a definite diagnosis. A male patient visited the Second Xiangya Hospital, Central South University for consistent cough and sputum production for about 1 year. Anti-infection therapy was given but it showed ineffectiveness. Enteric adenocarcinoma was diagnosed after percutaneous lung biopsy according to pathological findings. Combining this case with relevant literature, we summarized the characteristics to raise physicians' awareness for this rare subtype.
Adenocarcinoma/surgery* ; Adenocarcinoma of Lung ; Humans ; Lung ; Lung Neoplasms ; Male

No abstract available.
Adenocarcinoma* ; Diagnosis* ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis*

Pathologists play an increasingly important role in personalized medicine for patients with lung cancer as a result of the newly recognized relationship between histologic classification and molecular change. In 2011, the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) proposed a new architectural classification for invasive lung adenocarcinomas to provide uniform terminology and diagnostic criteria. This review highlighted the evolution of the classification of lung adenocarcinomas in resected specimens with special respect to both histologic subtyping and invasion. Histologic subtyping of lung adenocarcinoma has been updated based on five major predominant patterns. New concepts of adenocarcinoma in situ and minimally invasive adenocarcinomas have been introduced to define the condition of patients who are expected to have excellent survival. Although the new IASLC/ATS/ERS classification has promising clinical relevance, significant clarification remains necessary for the definitions of subtyping and invasion. More precise definitions and subsequent better education on the interpretation of terminology will be helpful for future studies.
Adenocarcinoma ; Humans ; Precision Medicine ; Lung ; Lung Neoplasms

We experienced a case of micropapillary lung adenocarcinoma with aerogenous spread in a patient who was suspected of having interstitial pneumonia. To our knowledge, our case has not been described in the Korean literature. Our case indicates that clinicians cannot rule out the possibility of micropapillary lung adenocarcinoma with aerogenous spread in patients with a persistent presence of lesions in the lower left lung.
Adenocarcinoma* ; Humans ; Lung Diseases, Interstitial ; Lung* ; Pneumonia