Satoh Hironori, Okuma Yusuke, Kashima Jumpei, Konnno-Yamamoto Aya, Yatabe Yasushi, Ohe Yuichiro
Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
Department of Pathology, National Cancer Center Hospital, Tokyo, Japan.
Onco Targets Ther. 2021 Apr 30;14:2911-2915. doi: 10.2147/OTT.S300229. eCollection 2021.
Miliary pulmonary metastasis characterized by tiny nodules is a rare metastatic pattern in advanced non-small cell lung cancer (NSCLC) and is usually seen in patients harboring an mutation, and amylase-producing lung cancer is highly uncommon and rarely reported in NSCLC patients who have an mutation.
A 32-year-old Japanese female was found to have miliary pulmonary nodules throughout both lung fields on a chest x-ray examination during an annual health check-up. Further examination by computed tomography (CT) revealed diffuse, bilateral, miliary nodules. Blood tests showed no increased tumor marker levels, but there was a significantly increased serum amylase level. A diagnosis of -rearranged adenocarcinoma was made based on the results of a mediastinal lymph node biopsy obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Treatment with alectinib resulted in rapid regression of the CT shadows and a reduction in the patient's serum amylase level.
We have reported a case of -rearranged NSCLC with a miliary pulmonary metastasis pattern that was sensitive to alectinib and in which the serum amylase level decreased in response to treatment with alectinib. Young patients with miliary pulmonary metastasis should be checked for all driver mutations.
以微小粟粒结节为特征的粟粒性肺转移是晚期非小细胞肺癌（NSCLC）中一种罕见的转移模式，通常见于携带某种突变的患者，而产生淀粉酶的肺癌极为罕见，在携带该突变的NSCLC患者中鲜有报道。
一名32岁日本女性在年度健康检查的胸部X光检查中发现双肺野布满粟粒性肺结节。计算机断层扫描（CT）进一步检查显示双侧弥漫性粟粒结节。血液检查显示肿瘤标志物水平未升高，但血清淀粉酶水平显著升高。根据经支气管超声引导下经支气管针吸活检（EBUS-TBNA）获取的纵隔淋巴结活检结果，诊断为某种重排腺癌。使用阿来替尼治疗导致CT阴影迅速消退，患者血清淀粉酶水平降低。
我们报告了一例具有粟粒性肺转移模式的某种重排NSCLC病例，该病例对阿来替尼敏感，且使用阿来替尼治疗后血清淀粉酶水平下降。对于有粟粒性肺转移的年轻患者，应检查所有驱动基因突变。
