J Pathol Transl Med.  2021 Jan;55(1):79-82. 10.4132/jptm.2020.11.02.

EGFR-mutated pulmonary adenocarcinoma with concurrent PIK3CA mutation, and with acquired RET fusion and EGFR T790M mutation after afatinib therapy

Affiliations
  • 1Department of Pathology, Gyeonsang National University Hospital, Jinju, Korea
  • 2Division of Hematology-Oncology, Department of Internal Medicine, Gyeonsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
  • 3Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeonsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
  • 4Department of Cardiothoracic Surgery, Gyeonsang National University Hospital, Jinju, Korea
  • 5Department of Pathology, Gyeonsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea


Figure

  • Fig. 1 Clinical course and pathological diagnosis of the patient. Adenocarcinoma was diagnosed using pleural fluid (A), and lung needle biopsy (B). Lung wedge resection specimen showed tumor heterogeneity; solid and cribriform components (C), and acinar and papillary components (D). (E) Metastatic adenocarcinoma was observed in the axillary LN. EGFR, epidermal growth factor receptor; PIK3CA, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha; NGS, next-generation sequencing; RT-PCR, reverse tranascription; LN, lymph node.

  • Fig. 2 Chest computed tomography. (A) Lung mass (arrow) in right upper lobe with pleural fluid (arrowhead) at diagnosis. (B) Decreased size of lung mass (arrow) and amount of pleural fluid (arrowhead) after 3 months of afatinib therapy. (C) Increased amount of pleural fluid (arrow) after 7.5 months with afatinib therapy. (D) Increased size of axillary (arrow) and mediastinal (arrowhead) lymph nodes after 3 months with osimertinib therapy.


Reference

References

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3. Wang L, Hu H, Pan Y, et al. PIK3CA mutations frequently coexist with EGFR/KRAS mutations in non-small cell lung cancer and suggest poor prognosis in EGFR/KRAS wildtype subgroup. PLoS One. 2014; 9:e88291.
4. Piotrowska Z, Isozaki H, Lennerz JK, et al. Landscape of acquired resistance to osimertinib in EGFR-mutant NSCLC and clinical validation of combined EGFR and RET inhibition with osimertinib and BLU-667 for acquired RET fusion. Cancer Discov. 2018; 8:1529–39.
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