Clinicopathological observation of primary lung enteric adenocarcinoma and its response to chemotherapy: A case report and review of the literature

Lin,Li; Xu,Chun‑Wei; Zhang,Bo; Liu,Rong‑Rui; Ge,Fei‑Jiao; Zhao,Chuan‑Hua; Jia,Ru; Qin,Quan‑Hong; Stojsic,Jelena; Wang,Yan; Xu,Jian‑Ming

doi:10.3892/etm.2015.2864

Clinicopathological observation of primary lung enteric adenocarcinoma and its response to chemotherapy: A case report and review of the literature

Authors:
- Li Lin
- Chun‑Wei Xu
- Bo Zhang
- Rong‑Rui Liu
- Fei‑Jiao Ge
- Chuan‑Hua Zhao
- Ru Jia
- Quan‑Hong Qin
- Jelena Stojsic
- Yan Wang
- Jian‑Ming Xu
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Affiliations: Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China, Department of Pathology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China, Department of Pathology, Tianjin First Center Hospital, Tianjin 30000, P.R. China, Service of Histopathology, Clinical Centre of Serbia, Belgrade 11000, Serbia
Published online on: November 12, 2015 https://doi.org/10.3892/etm.2015.2864
Pages: 201-207

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Abstract

Primary lung enteric adenocarcinoma is a rare type of invasive lung carcinoma. Its morphology and immunohistochemistry are those of colorectal carcinoma, but there is no associated primary colorectal carcinoma. The present study describes the case of a 53-year-old female who presented with an irritating cough and a mass around the right sternoclavicular joint. Comprehensive evaluation revealed involvement of the mediastinum, lungs, right sternoclavicular joint and right kidney. Biopsies from the mediastinal and right sternoclavicular joint tumors showed features of adenocarcinoma. Immunohistochemistry was positive for cytokeratin (CK)20 and caudal type homeobox transcription factor 2, and negative for CK7, thyroid transcription factor‑1 and napsin A. Genotypic analysis identified the expression of wild‑type epidermal growth factor receptor, Kirsten rat sarcoma viral oncogene homolog, serine/threonine‑protein kinase B‑Raf and UDP‑glucuronosyltransferase 1‑1. There was no expression of echinoderm microtubule‑associated protein‑like 4‑anaplastic lymphoma kinase and a moderate expression of excision repair cross‑complementation group 1, ribonucleoside‑diphosphate reductase large subunit and tubulin β‑3 chain. A strong expression of thymidylate synthase and 677TC genotype expression of methylenetetrahydrofolate reductase was observed. Gastroscopy, enteroscopy, colorectal colonoscopy and positron emission tomography‑computed tomography failed to find evidence of a gastrointestinal malignancy and primary lung enteric adenocarcinoma was diagnosed. The presence of multiple metastases did not permit curative surgery. The patient was treated with 3 monthly cycles of the XELOX chemotherapy regimen; the response was poor with progression of supraclavicular lesions. Treatment was switched to the TP regimen for 4 monthly cycles, which resulted in a significant reduction in the size of the lung lesions; however, the supraclavicular lesion responded poorly to the treatment. The patient then received 2 cycles of the FOLFIRI regimen; however, the lung and right supraclavicular lesions progressed, causing increased right upper limb pain. The pain was alleviated by palliative surgery. Following surgery, the DP regimen was employed. Follow‑up of the patient remains ongoing. The present findings suggest that the early diagnosis and treatment of primary lung enteric adenocarcinoma is likely to improve patient outcome.

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