PMC3594004_01
(A) Chest CT revealed a mass in the right upper lobe, with pleural effusion. (B) Abdominal CT revealed a low-density lesion in the liver.. Abbreviation: CT, computed tomography.
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Chest computed tomography (CT) revealed a pulmonary mass in the upper lobe of the right lung, with pleural indentation and massive pleural effusion (Figure 1A). Magnetic resonance imaging of the brain detected no evidence of metastasis, but a metastatic liver tumor was detected by abdominal CT (Figure 1B). The chest CT scan at day 14 after EGFR-TKI initiation revealed multiple liver metastases, increased right pleural effusion, enlargement of multiple metastatic liver tumors, and atelectasis of the middle lobe (Figures 3A and S1).
(A) Adenocarcinoma cells were evident in the right pleural effusion. TTF-1 was detected on tumor cell surfaces by immunohistochemical staining. (B) Tumor cells from the right pleural effusion harbored both a pretreatment T790M EGFR mutation in exon 20 and in-frame deletions in exon 19.. Note: This result was obtained using the PNA-LNA PCR clamp method.. Abbreviations: EGFR, epidermal growth factor receptor; PNA-LNA PCR, peptide nucleic acid-locked nucleic acid polymerase chain reaction; T790M, threonine-methionine substitution mutation at position 790 in exon 20; TTF-1, thyroid transcription factor-1.
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Bronchoscopic and cytologic examination of the right pleural effusion revealed poorly differentiated adenocarcinoma (Figure 2A). The T790M EGFR mutation in exon 20 and an in-frame deletion in exon 19 were detected in tumor cells from the right pleural effusion using the peptide nucleic acid-locked nucleic acid polymerase chain reaction clamp (PNA-LNA PCR clamp) method (Figure 2B).
(A) Chest CT before docetaxel monotherapy revealed atelectasis of the right middle lobe, with right pleural effusion. (B) Chest CT revealing tumor response after two cycles of docetaxel. (C) Chest CT revealing tumor response after four cycles of docetaxel.. Abbreviation: CT, computed tomography.
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The chest CT scan at day 14 after EGFR-TKI initiation revealed multiple liver metastases, increased right pleural effusion, enlargement of multiple metastatic liver tumors, and atelectasis of the middle lobe (Figures 3A and S1). A chest CT after two and four cycles of this treatment (Figure 3B and C) revealed tumor regression and decreased right pleural effusion.