Alhariri Bassem, Elfatih Arwa, Elhassan Osman Osama, Elfatih Mohamed, Kheir Aya Mohamed, Elkhatib Razan
Department of Medicine Hamad Medical Corporation Doha Qatar.
College of Medicine Qatar University Doha Qatar.
Respirol Case Rep. 2025 Jun 5;13(6):e70170. doi: 10.1002/rcr2.70170. eCollection 2025 Jun.
A 34-year-old Ghanaian male with no past medical history presented to our hospital with dyspnoea, left-sided chest pain, and left-eye visual disturbance. Imaging revealed a large mediastinal mass with vascular invasion, left pleural and skeletal metastases. A lung biopsy confirmed lung adenocarcinoma (LUAD) with mixed solid and lepidic growth patterns, showing 80% PD-L1 expression. Positron emission tomography (PET) identified a highly active lesion in the left eye, suggestive of retinal metastasis. Ophthalmologic evaluation confirmed retinal involvement. Given ROS1 positivity, Crizotinib was initially prescribed but switched to Lorlatinib due to concerns regarding retinal involvement. The patient demonstrated rapid clinical improvement, including notable visual recovery, with stable performance status after 1 month. This case underscores LUAD's potential for atypical metastasis, such as to the retina, necessitating comprehensive assessment and personalised management strategies. The shift from Crizotinib to Lorlatinib highlights the importance of targeted therapy in managing advanced NSCLC with rare metastatic involvement.
一名34岁无既往病史的加纳男性因呼吸困难、左侧胸痛和左眼视力障碍就诊于我院。影像学检查发现一个伴有血管侵犯的巨大纵隔肿块，左侧胸膜和骨骼转移。肺活检证实为肺腺癌（LUAD），具有实性和鳞屑状混合生长模式，显示80%的程序性死亡配体1（PD-L1）表达。正电子发射断层扫描（PET）在左眼中发现一个高活性病变，提示视网膜转移。眼科评估证实视网膜受累。鉴于ROS1阳性，最初开具了克唑替尼，但由于担心视网膜受累而改用劳拉替尼。患者临床症状迅速改善，包括视力明显恢复，1个月后体能状态稳定。该病例强调了LUAD发生非典型转移（如转移至视网膜）的可能性，需要进行全面评估和个性化管理策略。从克唑替尼转换为劳拉替尼凸显了靶向治疗在管理伴有罕见转移的晚期非小细胞肺癌中的重要性。
