PMC7498275_01
PET-CT showing metabolically active metastatic lesion in the upper lobe of left lung along with metabolically active moderate left side pleural effusion.
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Staging positron emission tomography-computed tomography (PET-CT) was done which showed metabolically active lung disease (upper left lobe) and metabolically active nodular thickenings in the left mediastinal, diaphragmatic and coastal pleura along with metabolically active moderate left side pleural effusion (Figure 1).
Pleural nodule biopsy (200x). (a) - H&E showing deposits of adenocarcinoma. (b) - Tumour cells expressing CK7. (c) - Tumour cells expressing CDX2. (d) - Tumour cells focally expressing GATA-3.
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The tumour cells were diffusely positive for CK7, focally CDX2and GATA-3 while were negative for TTF-1, ER, PR, HER2 and CK20 (Figure 2a-d).
PMC7498275_02
EGFR 21 L861Q Mutation was detected using home brew targeted TaqMan primer probes on the Real Time PCR platform LC 480 II.
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In view of poor PS and to have fair evidence to rule out primary lung carcinoma, reverse transcription polymerase chain reaction for EGFR was ordered which confirmed exon21 L861Q mutation positivity (Figure 3).
Contrast enhanced computed tomography (CECT) scan showing decrease in left sided pleural effusion with near stable diffuse pleural thickening along with decrease in consolidation.
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figure4
She was continued on the same drug and an assessment contrast enhanced computed tomography (CECT) scan was carried out on August, 14th, 2019 (after 3 months of starting the drug) which showed a partial response (Figure 4).