PMC4956058_01
Treatment of lung adenocarcinoma with sarcomatoid differentiation using different chemotherapy regimens and results of monitoring the CEA levels.. Notes: (A-D) Lung CT scans from (A) November 2015, (B) December 2015, (C) January 2016, and (D) February 2016. (E-H) CT scans of the mediastinum from (E) November 2015, (F) December 2015, (G) January 2016, and (H) February 2016.. Abbreviations: CEA, carcinoembryonic antigen; CT, computed tomography.
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November 2015 (Figure 1). No significant medical history was reported and no abnormalities were found on physical examination. No recurrence of the tumor was noted by CT scanning during 3 months of follow-up care (Figure 1). The CEA level ranged from a pretreatment level of 3.41 ng/mL to a postoperative level of 2.29 ng/mL (Figure 1).
The hematoxylin-eosin staining and the immunohistochemistry in the part of adenocarcinoma and sarcomatoid differentiation.. Notes: (A) The hematoxylin-eosin staining revealed that tumor cells were lung adenocarcinoma (x100). (B) The hematoxylin-eosin staining revealed that tumor cells were sarcomatoid differentiation (x100). (C) Immunohistochemical examination revealed that tumor cells were positive for monoclonal anti-CK7 antibody in a portion of the adenocarcinoma (x100). (D) Immunohistochemical examination revealed that tumor cells were positive for monoclonal anti-CK7 antibody in a portion of the sarcomatoid differentiation (x100). (E) Immunohistochemical examination revealed that tumor cells were positive for monoclonal anti-TTF-1 antibody in a portion of the adenocarcinoma (x100). (F) Immunohistochemical examination revealed that tumor cells were positive for monoclonal anti-TTF-1 antibody in a portion of sarcomatoid differentiation (x100). (G) Immunohistochemical examination revealed that tumor cells were positive for monoclonal antivimentin antibody in a portion of adenocarcinoma (x100). (H) Immunohistochemical examination revealed that tumor cells were positive for monoclonal antivimentin antibody in a portion of sarcomatoid differentiation (x100).
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The postoperative pathology showed that the tumor was an adenocarcinoma with sarcomatoid differentiation (Figure 2). Immunochemistry staining was positive for the following markers: vimentin; thyroid nuclear factor 1; P63; cytokeratin 7; and cytokeratin 5/6 (Table 1 and Figure 2).
Schema shows tumor with dual drivers (CD74-ROS1 fusion gene by polymerase chain reaction and EGFR exon 21 L858R point mutation by next-generation sequencing) in a portion of the adenocarcinoma (1), and tumor with no driver or unknown driver in a portion of the sarcomatoid differentiation (2).
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A variant of the ROS1 translocation (Table 2 and Figure 3) and the EGFR exon 21 L858R point mutation were detected (Table 3 and Figure 3).