Hoffman Seth A, Manski Scott, Deepak Janaki
Division of Internal Medicine, University Of Maryland School Of Medicine, Baltimore, Maryland, USA.
Division of Pulmonary and Critical Care Medicine, University Of Maryland School of Medicine, Baltimore, Maryland, USA.
BMJ Case Rep. 2019 May 30;12(5):e228534. doi: 10.1136/bcr-2018-228534.
A 64-year-old African American man, with a history of prostate adenocarcinoma treated in 2009 and a greater than 50-pack-year tobacco smoking history, presented with 2-3 weeks of non-productive cough, frontal headache and generalised myalgias and arthralgias. CT was positive for diffuse, miliary opacities in bilateral lung fields. He was diagnosed with stage four lung adenocarcinoma, negative for epidermal growth factor receptor (EGFR) gene mutation. The patient was unable to tolerate therapy and passed away approximately 4 months after his diagnosis. Previous case reports and research have suggested an association between EGFR gene mutation and miliary patterned lung metastases in non-small cell lung cancer. This case suggests that the mechanism by which miliary patterned metastases occur is more complex than purely mutation of the EGFR gene. Further study may elucidate novel molecular targets for treatment, especially in patients with rapidly progressive disease such as the patient we describe.
一名64岁的非裔美国男性，有2009年前列腺腺癌治疗史，吸烟史超过50包年，出现2至3周的干咳、前额头痛以及全身肌痛和关节痛。CT显示双侧肺野弥漫性粟粒状阴影呈阳性。他被诊断为四期肺腺癌，表皮生长因子受体（EGFR）基因突变阴性。该患者无法耐受治疗，诊断后约4个月去世。既往病例报告和研究表明，EGFR基因突变与非小细胞肺癌的粟粒样肺转移之间存在关联。本病例提示，粟粒样转移发生的机制比单纯的EGFR基因突变更为复杂。进一步的研究可能会阐明新的治疗分子靶点，尤其是对于像我们所描述的这种病情快速进展的患者。
