Wang Yong, Chen Lin, Wang Zhi, Liu Shubin
Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, 17 Yongwai Zheng Road, Nanchang.
Department of Medical Oncology, The Affiliated Ganzhou Hospital of Nanchang University (Ganzhou People's Hospital), 16 Meiguan Road, Ganzhou.
Medicine (Baltimore). 2020 Oct 16;99(42):e22636. doi: 10.1097/MD.0000000000022636.
The cervix is a rare site of metastasis from advanced lung adenocarcinoma. Driven gene detection is particularly important for the treatment of advanced lung adenocarcinoma.
A 49-year-old Chinese female was sent to our hospital because of lumbago and sacroiliac joint pain; she was unable to walk and had vaginal bleeding. The following examinations were performed: imaging, colposcopy, bronchoscopy, immunohistochemistry and next-generation sequencing.
According to the clinical manifestations and the examination results, the diagnosis was lung adenocarcinoma with cervical, brain, adrenal gland and bone metastases. More importantly, EGFR gene mutations (del19) were detected in both the primary lung lesion and uterine cervical biopsy specimen.
Osimertinib was chosen as the first-line treatment.
Lumbago and sacroiliac joint pain were significantly relieved. The levels of tumor markers decreased. Primary injuries and metastatic sites were significantly reduced.
Physicians should be alert to the signals of vaginal bleeding and consider that primary lung adenocarcinoma may metastasize to the uterine cervix.
宫颈是晚期肺腺癌罕见的转移部位。驱动基因检测对晚期肺腺癌的治疗尤为重要。
一名49岁中国女性因腰痛和骶髂关节疼痛被送至我院；她无法行走且有阴道出血。进行了以下检查：影像学检查、阴道镜检查、支气管镜检查、免疫组化检查和二代测序。
根据临床表现及检查结果，诊断为肺腺癌伴宫颈、脑、肾上腺及骨转移。更重要的是，在原发性肺部病灶和子宫颈活检标本中均检测到表皮生长因子受体（EGFR）基因突变（19号外显子缺失）。
选择奥希替尼作为一线治疗药物。
腰痛和骶髂关节疼痛明显缓解。肿瘤标志物水平下降。原发性损伤和转移部位明显缩小。
医生应警惕阴道出血信号，并考虑原发性肺腺癌可能转移至子宫颈。
