PMC6091473_01
H&E staining (A), 100x, and immunohistochemistry (B) for TTF-1, (C) for CK7, (D) for Napsin A, 100x, of the specimen, which showed lung adenocarcinoma.
ott-11-4739Fig1.jpg
PMC6091473_01_ott-11-4739Fig1.jpg
f1-ott-11-4739
H&E staining showed morphology typical of adenocarcinoma cells (Figure 1A). Immunohistochemistry demonstrated strong positivity for CK7, and weak staining of TTF-1, Napsin A (Figure 1B-D).
Next-generation sequencing showed R670W in epidermal growth factor receptor exon 17 (A), and H835L, L833V (B), and T790M (C) in exon 21.
ott-11-4739Fig2.jpg
PMC6091473_01_ott-11-4739Fig2.jpg
f2-ott-11-4739
The results showed that the patient had 3 uncommon EGFR mutations: EGFR-R670W in exon 17, H833V in exon 21, and H835L in exon 21 (Figure 2).
Treatment of lung adenocarcinoma using different regimens, and the results of monitoring the NGS of cfDNA.. Abbreviations: NGS, next-generation sequencing; cfDNA, cell-free DNA.
ott-11-4739Fig3.jpg
PMC6091473_01_ott-11-4739Fig3.jpg
f3-ott-11-4739
The patient was treated with oral gefitinib (250 mg, q.d.) on September 25, 2016 (Figure 3). The last follow-up was on January 24, 2018, at which point both the primary and metastatic brain lesions were stable, and T790M, H835L, and L833V disappeared (Figure 3).