From Icahn School of Medicine at Mount Sinai Bronx program, James J. Peters Veterans Affairs Medical Center, and Columbia University, New York, New York.
From Icahn School of Medicine at Mount Sinai Bronx program, James J. Peters Veterans Affairs Medical Center, and Columbia University, New York, New York. From Icahn School of Medicine at Mount Sinai Bronx program, James J. Peters Veterans Affairs Medical Center, and Columbia University, New York, New York.
J Natl Compr Canc Netw. 2015 Apr;13(4):387-91; quiz 391. doi: 10.6004/jnccn.2015.0054.
Hepatoid adenocarcinoma of the lung (HAL) is an extremely rare cancer without clear treatment guidance and with a poor prognosis. This report discusses a 64-year-old man who presented with complaints of hemoptysis and was found to have a right upper lobe (RUL) lung mass on chest CT with presence of a right hilar mass and retrocaval lymphadenopathy, and metastasis to the vertebral spine and rib. The patient was diagnosed with T2N2M1 (stage IV) unresectable disease. A biopsy of the RUL mass revealed hepatoid variant adenocarcinoma. Immunohistochemical stains showed tumor cells positive for CK7, AFP, Hep Par 1, napsin A, and cytoplasmic TTF-1 staining. In contrast, CK5, CK6, and CK20 were negative, and EGFR was wild-type. Serum alpha fetoprotein (AFP) level was elevated at 181 ng/mL. The patient was treated with platinum-based doublet chemotherapy and sorafenib, and his AFP level decreased to 25 ng/mL. This case report presents the novel use of sorafenib in combination with platinum-based doublet chemotherapy in EGFR wild-type HAL, which led to a partial response. Single-agent sorafenib led to stable disease overall, achieving a survival among the longest reported for unresectable stage IV, all while maintaining an ECOG performance status of 0 to 1.
肺肝样腺癌（HAL）是一种极为罕见的癌症，目前尚无明确的治疗指导，预后较差。本报告讨论了一位 64 岁男性，因咯血就诊，胸部 CT 显示右上肺叶（RUL）肿块，同时伴有右肺门肿块、腔静脉后淋巴结病以及脊柱和肋骨转移。患者被诊断为不可切除的 T2N2M1（IV 期）疾病。RUL 肿块的活检显示为肝样腺癌变体。免疫组化染色显示肿瘤细胞 CK7、AFP、Hep Par 1、napsin A 和细胞质 TTF-1 染色阳性，而 CK5、CK6 和 CK20 染色阴性，EGFR 为野生型。血清甲胎蛋白（AFP）水平升高至 181ng/mL。患者接受了铂类双联化疗和索拉非尼治疗，AFP 水平降至 25ng/mL。本病例报告介绍了索拉非尼联合铂类双联化疗在 EGFR 野生型 HAL 中的新应用，导致部分缓解。单药索拉非尼总体上使疾病稳定，实现了不可切除的 IV 期报告的最长生存时间，同时保持 ECOG 表现状态为 0 至 1。
