摘要
浙江省衢州市柯城区人民医院收治1例晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)。患者,女,65岁,无吸烟史,无肿瘤家族史。因"右下肺癌术后13年余,来院复查"入院。胸部增强CT示:两肺多发恶性肿瘤,左肺上叶最大层面约3.6cm×3.2cm,右肺最大层面约5.9c m×3.5c m,左侧第1 2肋膨胀性骨质破坏。头颅增强M R I示:双侧颞叶异常强化灶,大小约0.5 cm×0.5 cm,考虑转移。左肺穿刺病理:(左)肺非小细胞癌,倾向腺癌。免疫组织化学:CK7(+),napsin-A(+),TTF-1(+),p40(-),p63(-),Ki-67(5%+)。基因检测:EGFRE19del突变。一线予"吉非替尼片(易瑞沙)"靶向治疗,治疗后肺部病灶明显缩小,颅内病灶消失。16个月左右后疾病进展,进展后血液EGFRT790M突变检测阳性,使用"甲磺酸奥西替尼片(泰瑞沙)"治疗,疾病持续缓解中。
A 65-year-old female,never smoker,with advanced non-small cell lung cancer(NSCLC) was admitted to the Kecheng District People’s Hospital of Quzhou,Zhejiang Province.The patient denied a family history of cancer.Due to a 13-year surgery history of the right lower lung cancer,the patient wanted to conduct a review.Enhanced chest CT showed multiple malignant tumors in both lungs,the largest layer of the left upper lobe was about 3.6 cm ×3.2 cm,the largest part of the right lung was about 5.9 cm ×3.5 cm,and the left flank was expansive bone destruction.Enhanced cranial MRI showed abnormal enhancement of bilateral temporal lobe(about 0.5 cm ×0.5 cm),indicating metastasis.The pathology of left lung puncture was NSCLC and prone to adenocarcinoma.In the further immunohistochemistry study,the results demonstrated CK7(+),napsin-A(+),TTF-1(+),p40(-),p63(-),Ki-67(5%+).The genetic testing of tissue identified a common EGFR mutation(E19 del).Based on the above results,"gefitinib(Iressa)" was initiated as the first-line treatment.The lung lesions were significantly reduced and the intracranial lesions disappeared during gefitinib therapy.However,the disease progressed after 16 months and a novel EGFR mutation(T790 M) was detected.Hence,the patient acquired another targeted therapy with "oxitinib mesylate(Terisha)",and the disease continues to be relieved.
作者
陈清
王圣庄
鲍洁兰
蔡锦威
姜玲
王欣
CHEN Qing;WANG Shengzhuang;BAO Jielan;CAI Jinwei;JIANG Ling;WANG Xin(Department of Hematology and Oncology,Kecheng District People’s Hospital,Quzhou Zhejiang 324000,China)
出处
《临床与病理杂志》
2020年第1期252-258,共7页
Journal of Clinical and Pathological Research
