PMC6838794_01
Photomicrographs (A&B) showing a linear core of fibro collagenous tissue from lung infiltrated by atypical glands, suggestive of an adenocarcinoma (A, H&E, x20; B, H&E, x100). Tumor cells exhibit weak immunopositivity for TTF 1 (C, IHC, x200).
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PR, HER2NEU and GCDFP-15 Fig. 1. Patient was diagnosed as carcinoma lung with malignant pleural effusion, and started on palliative chemotherapy with Paclitaxel and Carboplatin.
Photomicrograph (A) from breast biopsy showing infiltration by an adenocarcinoma (H&E, x100; B, H&E, x100). Tumor cells are immunopositive for TTF 1 (B, IHC, x100), while negative for ER, PR, Her2Neu and GCDFP (C-F, IHC, x200).
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Biopsy from breast lesion showed metastatic adenocarcinoma, immunopositive for CK-7, TTF-1, while negative for ER, PR, Her2neu, CK 20, consistent with lung primary Fig. 2.
Endometrial aspirate showing a similar adenocarcinoma with glandular and solid areas (H&E, x200). Tumor cells are strongly immunopositive for TTF 1 (IHC, x100).
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Endometrial curettage was again consistent with metastatic adeno carcinoma immunopositive for TTF1 (clone 8G7G3/1) Fig. 3.
EGFR mutation detected from lung biopsy by DNA sequencing. E746_A750del mutation in exon 19 and T790M mutation in exon 20 are detected.
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Mutation analysis by DNA sequencing showed mutation in exon 19 and exon 20 in EGFR gene Fig. 4.
Mutation study from breast biopsy showing ALK D5F3 positive. Test Performed using Ventana anti -ALK (D5F3) Rabbit monoclonal primary antibody along with Ventana detection kit on a Ventana Benchmark XT autostainer.
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ALK mutation study by immunohistochemistry (D5F3) was positive in the breast biopsy Fig. 5.
FDG-Positron emission tomography - computed tomography (PET- CT) scan showing bilateral breast(A), ovarian and endometrial(B) metastasis.
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April 2016. After 11 months patient had progressive disease with increase in number of bone and brain metastasis with peritoneal deposits and adnexal mass and uptake in uterus Fig. 6.