Colon metastasis from lung adenocarcinoma with BRAF V600E mutation: A case report.
Colon metastasis from lung adenocarcinoma with BRAF V600E mutation: A case report.
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BRAF V600E 突变肺腺癌结肠转移一例报告
DOI：
10.3389/fimmu.2022.970879
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发表时间：
2022
影响因子：
7.3
通讯作者：
中科院分区：
文献类型：
--
作者：
原发性肺癌出现症状性结肠转移在临床实践中很少见。我们报告一例58岁晚期肺腺癌患者，在免疫治疗和化疗后出现腹部症状，包括腹胀和排便困难。患者被诊断为肺腺癌，全身正电子发射断层扫描-计算机断层扫描证实了多发性淋巴结、胸膜和肾上腺转移。分子检测显示BRAF V600 E突变和高程序性死亡配体1（PD-L1）表达。在一线抗程序性细胞死亡蛋白1免疫治疗联合化疗后，胸部淋巴结明显减少。然而，随后发生结肠梗阻、不完全性肠梗阻和骨转移。内镜组织学检查证实腺癌，但由于组织不足，无法识别原发性或继发性肿瘤。我们施行结肠切除术以移除阻塞物，术后组织病理显微镜证实肺腺癌转移。我们证实了BRAF V600 E突变和PD-L1高表达，并支持肺腺癌的分子特征。住院期间，患者出现无法忍受的骨转移疼痛，给予姑息性放疗。随后，患者接受达拉非尼加曲美替尼作为二线治疗。本报告讨论了原发性肺腺癌结肠转移的临床特征、病理学、影像学、分子特征评估和治疗。
Symptomatic colon metastasis from primary lung cancer is rare in clinical practice. We report the case of a 58-year-old patient with advanced lung adenocarcinoma who developed abdominal symptoms, including abdominal distention and difficulty defecating, after immunotherapy and chemotherapy. The patient was diagnosed with lung adenocarcinoma, and systemic positron emission tomography-computed tomography confirmed multiple lymph node, pleural, and adrenal metastases. Molecular detection indicated BRAF V600E mutation and high programmed death-ligand 1 (PD-L1) expression. After first-line anti-programmed cell death protein 1 immunotherapy combined with chemotherapy, the nodes in the chest remarkably diminished. However, it was followed by colon obstruction, incomplete ileus, and bone metastasis. Endoscopic histological examination confirmed adenocarcinoma but could not identify primary or secondary tumors due to insufficient tissue. We performed colon resection to remove the obstruction, and postoperative tissue pathological microscopy confirmed metastasis from the lung adenocarcinoma. We corroborated the BRAF V600E mutation and high PD-L1 expression and supported the molecular features of lung adenocarcinoma. During hospitalization, the patient presented with unbearable pain in the bone metastases, and palliative radiotherapy was administered. Then, the patient received dabrafenib plus trametinib as the second-line therapy. This report discusses the clinical characteristics, pathology, imaging, molecular profile assessments, and treatment of primary lung adenocarcinoma with colon metastasis.
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