Arai Hiroyuki, Sasada Shinji, Kaburaki Kyohei, Ochiai Ryosuke, Masuda Wataru
Department of Respiratory Medicine, Fraternity Memorial Hospital, Tokyo, JPN.
Department of Tumor Medicine, Teikyo University Hospital, Tokyo, JPN.
Cureus. 2025 Feb 27;17(2):e79740. doi: 10.7759/cureus.79740. eCollection 2025 Feb.
A 55-year-old male with type 2 diabetes mellitus presented with a left lung mass on chest X-ray. Serum blood test showed an elevated carcinoembryonic antigen of 27.5 ng/mL with normal alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II (PIVKA-II) levels. Computed tomography (CT) revealed a 73-mm oval mass in the left lower lobe S6 segment of the lung, left hilar lymphadenopathy, multiple nodules in liver segments S4/5, and multiple rib lesions. Bronchoscopy revealed a polypoid lesion in the left B6 bronchus, and biopsy demonstrated tumor cells resembling hepatocellular carcinoma. Immunohistochemical staining was diffuse positive for hepatocyte paraffin 1 (Hep Par 1) and CD10 and negative for thyroid transcription factor-1 (TTF-1), p40, synaptophysin, and cytokeratin 5/6 (CK5/6). In addition, programmed death-ligand 1 (PD-L1) expression by 22C3 immunohistochemistry was 40% positive for tumor cells, and the gene mutation analysis showed positive for Kirsten rat sarcoma viral oncogene homolog () non-G12C mutation. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) of the liver showed poor enhancement of the tumor interior, ring enhancement, and decreased Gd-EOB-DTPA uptake, suggesting necrotic liver metastasis. The patient was diagnosed with advanced non-small cell lung cancer of unknown histological subtype with clinical T4N1M1c stage ⅣB. After optimizing blood glucose control with insulin, treatment with durvalumab, tremelimumab, carboplatin, and nab-paclitaxel was initiated. Toxicities included anemia requiring blood transfusion, but no other severe adverse events, including immune-related adverse events, were observed. Both the primary lung and metastatic liver lesion showed a tendency to shrink. This regimen may be considered a promising treatment for non-small cell lung carcinoma resembling hepatoid carcinoma as it achieved survival beyond the previously reported median.
一名55岁的2型糖尿病男性患者，胸部X线检查发现左肺肿块。血清血液检查显示癌胚抗原升高至27.5 ng/mL，甲胎蛋白及维生素K缺乏或拮抗剂-II诱导蛋白（PIVKA-II）水平正常。计算机断层扫描（CT）显示左肺下叶S6段有一个73毫米的椭圆形肿块，左肺门淋巴结肿大，肝S4/5段有多个结节，以及多处肋骨病变。支气管镜检查发现左B6支气管有一个息肉样病变，活检显示肿瘤细胞类似于肝细胞癌。免疫组织化学染色显示肝细胞石蜡1（Hep Par 1）和CD10弥漫阳性，甲状腺转录因子-1（TTF-1）、p40、突触素和细胞角蛋白5/6（CK5/6）阴性。此外，22C3免疫组织化学检测的程序性死亡配体1（PD-L1）表达显示肿瘤细胞40%呈阳性，基因突变分析显示 Kirsten 大鼠肉瘤病毒癌基因同源物（）非G12C突变呈阳性。肝脏钆乙氧基苄基二乙三胺五乙酸（Gd-EOB-DTPA）增强磁共振成像（MRI）显示肿瘤内部强化不佳，呈环形强化，Gd-EOB-DTPA摄取减少，提示肝转移灶坏死。该患者被诊断为组织学亚型不明的晚期非小细胞肺癌，临床分期为ⅣB期T4N1M1c。在用胰岛素优化血糖控制后，开始使用度伐鲁单抗、曲美木单抗、卡铂和白蛋白结合型紫杉醇进行治疗。毒性反应包括需要输血的贫血，但未观察到其他严重不良事件，包括免疫相关不良事件。原发性肺和转移性肝病灶均有缩小趋势。由于该方案实现了超过先前报道中位数的生存期，因此可被认为是治疗类肝细胞癌非小细胞肺癌的一种有前景的治疗方法。
