Primary signet-ring cell carcinoma of the lung treated with crizotinib: A case report
Primary signet-ring cell carcinoma of the lung treated with crizotinib: A case report
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DOI：
10.3892/ol.2015.3003
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发表时间：
2015-05-01
期刊：
影响因子：
2.9
通讯作者：
Liu, Hong-Yun
中科院分区：
文献类型：
--
作者：
Hao, Yue-Qin;Tang, Hua-Ping;Liu, Hong-Yun
原发性肺印戒细胞腺癌（SRCA）是肺腺癌的一种极为罕见的亚型，预后差。SRC组分的存在被认为是EML 4-ALK阳性非小细胞肺癌（NSCLC）的一个显著临床病理学特征。克唑替尼是一种间变性淋巴瘤激酶抑制剂，既往研究已批准用于治疗EML 4-ALK NSCLC，但其对SRCA（一种极其罕见的肺腺癌亚型）的影响尚未阐明。因此，本研究旨在评价SRCA对克唑替尼的临床反应，并检查克唑替尼作为癌症治疗的潜在用途。一名43岁男性因呼吸困难入住青岛市立医院（中国青岛）。胸部计算机断层扫描（CT）显示右肺中叶有肿块。经支气管肺活检显示SRCA（70%）与低分化腺癌（30%）混合存在。免疫组化显示SRCA细胞呈细胞角蛋白（CK）7和甲状腺转录因子-1阳性，CK 20阴性。通过荧光原位杂交检测EML 4-ALK基因的倒位，并通过鼻胃管注射克唑替尼。该患者对克唑替尼有高度反应。呼吸困难症状缓解，心包积液和胸腔积液量逐渐减少。CT扫描显示肺部肿瘤消退。总体缓解为部分缓解。因此，克唑替尼是SRCA患者的一种有吸引力的治疗选择。然而，在本研究中，仅在治疗一个月后就出现了对克唑替尼的获得性耐药性。因此，在未来的研究中研究获得性克唑替尼耐药的机制将是有价值的。
Primary signet-ring cell adenocarcinoma (SRCA) of the lung is an extremely rare subtype of lung adenocarcinoma with a poor prognosis. The presence of an SRC component is considered to be a prominent clinicopathological characteristic of EML4-ALK-positive non-small cell lung cancer (NSCLC). Crizotinib, an anaplastic lymphoma kinase inhibitor, has been approved for the treatment of EML4-ALK NSCLC by previous studies, but its effect on SRCA, an extremely rare subtype of lung adenocarcinoma, has yet to be elucidated. Therefore, the present study aimed to evaluate the clinical response of SRCA to crizotinib, and examine the potential use of crizotinib as a treatment for the carcinoma. A 43-year-old male was admitted to the Qingdao Municipal Hospital (Qingdao, China) with dyspnea. Chest computed tomography (CT) revealed a mass in the middle lobe of the right lung. Transbronchial lung biopsies revealed the presence of SRCA (70%) mixed with poorly-differentiated adenocarcinoma (30%). Immunohistochemically, the SRCA cells were positive for cytokeratin (CK)7 and thyroid transcription factor-1, and negative for CK20. An inversion of the EML4-ALK gene was detected by fluorescence in situ hybridization and crizotinib was injected by nasogastric tube. The patient was highly responsive to crizotinib. The symptoms of dyspnea were relieved and the volumes of pericardial and pleural effusion were gradually reduced. A CT scan revealed lung tumor regression. The overall response was a partial response. Therefore, crizotinib exists an attractive therapeutic option for patients with SRCA. However, in the present study, acquired drug resistance to crizotinib developed after only one month of treatment. It would consequently be valuable to investigate the mechanisms underlying acquired crizotinib resistance in future studies.