Department of Pathology, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Pathol Int. 2024 Sep;74(9):546-551. doi: 10.1111/pin.13464. Epub 2024 Jul 17.
Hepatoid adenocarcinoma of the lung is a rare variant of adenocarcinoma. We describe a case of hepatoid adenocarcinoma of the lung that harbored KRAS G12C and responded favorably to sotorasib. A man in his 70s was found to have an abnormality on his chest X-ray. He underwent right middle lobectomy, and a pathological examination of the surgical specimen showed conventional invasive adenocarcinoma with highly focal hepatoid adenocarcinoma. He received chemoradiotherapy and concurrent radiation, followed by durvalumab for postoperative recurrence. After three doses of durvalumab, he reported feeling short of breath. A computed tomography scan showed emerging broad consolidation in the right lower lobe. Transbronchial lung biopsy specimens from the consolidation showed hepatoid adenocarcinoma harboring KRAS G12C mutation. Therefore, he was started on sotorasib 960 mg daily. Eight days later, a computed tomography scan showed that the area of consolidation had reduced in size. Progressive disease was detected after 42 days of treatment with sotorasib. The patient died 1 month after cessation of sotorasib and 3 months after postoperative recurrence. We have encountered what we believe to be the first case of hepatoid adenocarcinoma of the lung with KRAS G12C mutation that responded favorably to treatment with sotorasib.
肺肝样腺癌是腺癌的一种罕见变异型。我们描述了一例肺肝样腺癌病例，该病例存在 KRAS G12C 突变，并对索托拉西布治疗有良好反应。一名 70 多岁的男性在胸部 X 光片上发现异常。他接受了右中叶切除术，手术标本的病理检查显示常规浸润性腺癌伴高度局灶性肝样腺癌。他接受了放化疗和同步放疗，随后接受了度伐利尤单抗治疗术后复发。在接受三剂度伐利尤单抗后，他自述呼吸急促。计算机断层扫描显示右下叶出现广泛实变。实变处的经支气管肺活检标本显示存在 KRAS G12C 突变的肝样腺癌。因此，他开始每日服用 960mg 的索托拉西布。8 天后，计算机断层扫描显示实变区域缩小。索托拉西布治疗 42 天后检测到疾病进展。在停止使用索托拉西布治疗后 1 个月和术后复发后 3 个月，患者死亡。我们遇到了我们认为的首例肺肝样腺癌伴 KRAS G12C 突变对索托拉西布治疗有良好反应的病例。
