Molecular Testing in Multiple Synchronous Lung Adenocarcinomas: Case Report and Literature Review

International Journal of Surgical Pathology
Oana C RafaelAdnan Hasanovic

Abstract

Discovery of driver mutations in pulmonary adenocarcinoma has revolutionized the field of thoracic oncology with major impact on therapy and diagnosis. Testing for EGFR, ALK, and KRAS mutations has become part of everyday practice. We report a case with multiple synchronous primary pulmonary adenocarcinomas in a 72-year-old female with previous history of smoking. The patient presented with cough and bilateral lung ground glass opacities. A positron emission tomography/computed tomography scan showed no activity in mediastinal lymph nodes. She underwent a left upper lobe biopsy and a right upper lobe wedge resection. Pathology revealed 4 morphologically distinct adenocarcinoma foci, suggestive of synchronous primary lung tumors. Molecular testing demonstrated no mutation in the left tumor. Three different driver mutations were present in the right lung tumors: KRAS codon 12 G12D and G12V and EGFR exon 21 L858R mutation, confirming the initial histologic impression. Subsequently, left upper lobe lobectomy showed 3 additional foci of adenocarcinoma with different morphologies, suggestive of synchronous primaries as well. No additional molecular testing was performed. Synchronous pulmonary adenocarcinomas are not uncommon; however...Continue Reading

References

Aug 29, 2007·The Journal of Thoracic and Cardiovascular Surgery·Yih-Leong ChangYung-Chie Lee
Aug 13, 2009·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Nicolas GirardColin B Begg
Sep 24, 2009·The American Journal of Surgical Pathology·Nicolas GirardWilliam D Travis
Oct 22, 2009·Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer·Jin-Haeng ChungChoon-Taek Lee
Jan 27, 2010·Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer·David J FinleyBernard J Park
Dec 14, 2011·Interactive Cardiovascular and Thoracic Surgery·Amir H SepehripourRajesh Shah
Mar 9, 2012·The New England Journal of Medicine·Marco GerlingerCharles Swanton
Dec 5, 2012·Acta Cytologica·Edmond S K MaChris L P Wong

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Citations

Mar 27, 2018·Thoracic Cancer·Tomoshige WakayamaYasutsugu Fukushima
Mar 9, 2020·American Journal of Clinical Pathology·Carlos A PaganAnjali Saqi

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Methods Mentioned

BETA
biopsy
dissection
surgical resection

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