A 58 year-old woman was diagnosed with lung adenocarcinoma (cT3N1M0). We detected a point mutation in epidermal growth factor receptor (EGFR) exon 21 (L858R) and an echinoderm microtubule-associated protein-like 4- anaplastic lymphoma kinase (ALK) rearrangement. The patient was treated with preoperative neoadjuvant chemotherapy and underwent a left lower lobectomy with mediastinal lymph node dissection. However, we could not detect any mutation in EGFR or the ALK rearrangement from the tumor tissue removed. Then, 70 days after completion of adjuvant chemotherapy, she visited our outpatient clinic with diminished visual accuracy and tinnitus. A single brain metastatic lesion was seen on brain magnetic resonance imaging. She underwent surgical removal of the brain mass, which showed a mutation of EGFR, exon 21, but no ALK rearrangement. We report this unusual case of lung adenocarcinoma with a coexisting EGFR mutation and ALK rearrangement, and identify gene alterations before chemotherapy, after chemotherapy, and at recurrence.
Adenocarcinoma* ; Ambulatory Care Facilities ; Brain ; Chemotherapy, Adjuvant ; Drug Therapy ; Exons ; Female ; Humans ; Lung* ; Lymph Node Excision ; Lymphoma ; Magnetic Resonance Imaging ; Phosphotransferases ; Point Mutation ; Receptor, Epidermal Growth Factor ; Recurrence ; Tinnitus

Choroidal metastasis from colorectal cancer is very rare and has not been reported before in Korea. We report a case of eye hyperemia and discomfort in a patient with advanced colon cancer. Orbit magnetic resonance imaging and positron emission tomography revealed an enhancing mass within the temporal side of the left orbit, suggestive of choroidal metastasis from the colorectal adenocarcinoma. The condition's rarity may be due to the long and distant pathway from the colon to the orbit. The presentation usually suggests extensive hematogeneous cancer dissemination and a poor prognosis. However, palliative radiotherapy may be an effective treatment for choroidal metastasis.
Adenocarcinoma ; Choroid* ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Humans ; Hyperemia ; Korea ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Orbit ; Positron-Emission Tomography ; Prognosis ; Radiotherapy*

Idiopathic pleuroparenchymal fibroelastosis (PPFE) is a rare, recently classified entity that consists of pleural and subjacent parenchymal fibrosis predominantly in the upper lungs. In an official American Thoracic Society/European Respiratory Society statement in 2013, this disease is introduced as a group of rare idiopathic interstitial pneumonias. We describe a case of a 76-year-old woman with cough and recurrent pneumothorax. She was admitted to our hospital with severe cough at first. High resolution computed tomography (HRCT) disclosed multifocal subpleural consolidations with reticular opacities in both lungs, primarily in the upper lobes, suggesting interstitial pneumonia. Rheumatoid lung was diagnosed initially through an elevated rheumatoid factor, HRCT and surgical biopsy at the right lower lobe. However, one month later, pneumothorax recurred. Surgical biopsy was performed at the right upper lobe at this time. The specimens revealed typical subpleural fibroelastosis. We report this as a first case of idiopathic PPFE in Korea after reviewing the symptoms, imaging and pathologic findings.
Aged ; Biopsy ; Cough ; Female ; Fibrosis ; Humans ; Idiopathic Interstitial Pneumonias ; Korea ; Lung ; Lung Diseases, Interstitial ; Pneumothorax* ; Rheumatoid Factor