Large-cell neuroendocrine carcinoma of lung with epidermal growth factor receptor (EGFR) gene mutation and co-expression of adenocarcinoma markers: a case report and review of the literature

PURPOSE: A high rate of response to treatment with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) has been observed in certain patients (women, of East Asian ethnicity, with non-smoking history and adenocarcinoma histology) with mutations in exons 18 to 21 of the tyrosine kinase domain of EGFR. Some cases of high-grade neuroendocrine carcinoma of the lung harboring mutations have been sporadically reported. METHODS: We describe the case of a 78-year-old woman with large-cell neuroendocrine carcinoma of the lung, with mutation in exon 21 L858R and co-expression of adenocarcinoma markers. RESULTS: A mass (3.0 cm in diameter) was identified in the inferior lobe of the left lung, accompanied by metastases into ipsilateral mediastinal lymph nodes and elevations of serum pro-gastrin-releasing peptide and carcinoembryonic antigen. Initial transbronchial brushing cytology suggested high-grade neuroendocrine carcinoma favoring small-cell carcinoma in poorly smeared and degenerated preparations, and revealed exon 21 L858R mutation. Re-enlargement of the cancer and bone metastases was observed after chemotherapy, and further testing suggested large-cell neuroendocrine carcinoma with immunoreactivity to markers of primary lung adenocarcinoma and L858R mutation. High-grade neuroendocrine carcinoma with mutations in the tyrosine kinase domain of EGFR may be associated with adenocarcinoma, as reviewed from the literature and may also apply to our case. CONCLUSIONS: EGFR-TKI could provide better quality of life and survival in patients with advanced or relapsed high-grade neuroendocrine carcinoma with EGFR gene mutations. Further studies in this respect are warranted

Case Report Successful Erlotinib Treatment for a Patient with Gefitinib-Related Hepatotoxicity and Lung Adenocarcinoma Refractory to Intermittently Administered Gefitinib

A 73-year-old Japanese man was histologically diagnosed with lung adenocarcinoma harboring an exon 19 deletion in the epidermal growth factor receptor. The patient was treated with gefitinib for 6 weeks until he developed substantially elevated hepatic enzyme levels that resulted in the discontinuation of gefitinib. Gefitinib was reintroduced with an intermittent treatment schedule after the transaminase levels normalized, but the patient's enzyme levels rose again, and the cancer progressed. Gefitinib was eventually replaced with erlotinib. There was stable disease for 7 weeks without any signs of liver toxicity. Thus, erlotinib may be a beneficial and well-tolerated treatment option for patients with gefitinib-related hepatotoxicity

Repetitive abdominal pain in a reproductive‐aged woman

Key Clinical Message We report a young woman with ileocecal endometriosis who presented with repeated abdominal pain. Under hormonal effects, the endometrium may proliferate and cause bleeding in the bowel wall, leading to cyclical abdominal pain. When recurring abdominal pain is observed in reproductive‐aged women, physicians should always be aware of gastrointestinal endometriosis

Effects of steroids on bone mineral content in women with bronchial asthma

The effects of corticosteroids on bone mass in patients with bronchial asthma (BA) are still controversial. To elucidate whether steroid administration may influence bone mineral content (BMC) and bone mineral density (BMD) in women with BA, a longitudinal study was designed for adult female asthmatics receiving long-term steroid therapy. We measured whole body BMC and lumbar BMD by dual energy X-ray absorptiometry in 23 women with BA and compared the results with those from 17 age-matched controls. Both patient and control groups were followed up for at least 1 year (mean (± SD) observation period 94 ± 33 weeks). We divided the asthmatic patients into two groups on the basis of the mode of steroid administration: (i) group A consisted of 10 patients with low dose oral steroid administration (prednisolone 5–10 mg daily); and (ii) group B consisted of 13 patients with low dose beclomethasone dipropionate (BDP) inhalation therapy (BDP 400–800 mg daily). There were no significant differences in both baseline values and changes of BMC and BMD among the three groups. These results demonstrate that asthmatic patients show normal bone mass and that both low dose steroid administration and BDP inhalation do not significantly affect BMC in patients with BA over the period studied. We suggest that appropriate steroid use does not augment bone mineral loss in asthmatics