Abstract
Introduction: Lung cancer is the leading cause of cancer death worldwide. Histologic transformation from lung squamous cell carcinoma to small cell lung cancer (SCLC) has become more and more, and its treatment is challenging because of unknown pathogenesis. Presentation of Case: A 62-year-old male patient presented with histologic transformation from primary lesion to metastatic recurrence lesion within 3 years following primary lobectomy and adjuvant chemotherapy. The patient had the symptom of cough at the time of initial illness and recurrence. The primary lesion at the root segment of left superior lobe was diagnosed as lung squamous cell carcinoma without gene mutation (including EGFR, ALK, BRAF V600E, etc.), and recurrence lesion at the swollen lymph nodes in mediastinum (4L group) was diagnosed as SCLC. Up to now, the patient was alive for nearly 4 years after first surgery. Discussion: Surgical resection is the main treatment for lung cancer patient in early stage. Lymph node metastasis is a big threat for the patients in early stage. Recently, the research reports focused on the mechanism and cases of histologic transformation of lung cancer have become more and more. In this case, histologic transformation from squamous cell carcinoma in primary focus to SCLC in metastatic lymph node lesion following lobectomy and adjuvant chemotherapy. However, there was no gene mutation. This is a very unusual report. Conclusion: We analyzed a lung cancer patient with histologic transformation from primary focus to lymphatic metastasis by clinical symptoms, radiologic features, laboratory tests, gene detection, histopathologic characteristics, and immunohistochemical testing. It is helpful to understand the pathogenesis of histologic transformation and metastatic progression for optimizing treatment measures to lung cancer.
Highlights
Lung cancer is the leading cause of cancer death worldwide
Most of them are associated with EGFR mutation in the presence of histologic transformation from adenocarcinoma to small cell lung cancer (SCLC)[4]
Surgical resection is the main treatment for lung cancer patients, especially for the patient in early stage, but patients with resected early stage had high recurrence rate and low long-term survival rate[6]
Summary
Lung cancer is the leading cause of cancer death worldwide, and the recurrence and metastasis are the main threats to human beings. We present a peculiar case with histologic transformation from lung squamous cell carcinoma in primary lesion to SCLC in metastatic lymph node lesion following lobectomy and adjuvant chemotherapy, and no gene mutation. Emission computed tomography showed the concentration area of imaging agent distribution was in the anterior aspect of the left seventh and eighth ribs, the right sternoclavicular joint and the right forearm; there was no abnormal thickening, thinning, and defect area of imaging agent distribution in the rest of body bone This indicated that bone metabolism was more active in these areas than that in other areas (Fig. 1C). The result of pathologic examination was lung squamous cell carcinoma (well-moderate differentiated) with metastatic lymph node lesion around the splenic hilum (Station No 10). Endobronchial ultrasound-guided transbronchial needle aspiration was performed for the swollen lymph nodes in mediastinum (4L group)
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