以恶性胸腔积液为主要表现的EGFR T790M突变型肺腺癌1例及文献复习

Malignant pleural effusion as main manifestation of EGFR T790M mutation lung adenocarcinoma: A case report and literature review

报告1例64岁的晚期肺腺癌男性病例,患者主因咳嗽伴胸闷1个月于2017年4月22日第1次入院。CT显示左侧胸腔积液,正电子发射计算机断层显像(positiron emission tomography-computed tomography,PET-CT)示左侧胸膜稍增厚,局部胸膜见结节状异常葡萄糖高代谢,经胸腔镜胸膜活检术,胸膜病理:腺癌(考虑肺源性)。胸水细胞学回报:找到腺癌细胞,考虑肺来源。胸水脱落细胞基因检测EGFR 19del阳性,口服厄洛替尼治疗,胸水消失,多次肺部结节影像评估为部分缓解及稳定。2018年6月30日主因胸闷气短再次入院,考虑病情进展,胸部超声提示左侧胸腔大量胸腔积液。行胸腔闭式引流术,引流出约700 mL暗血性液体,细胞学诊断:找到癌细胞,胸水细胞EGFR基因检测结果:19DEL阳性,T790M阳性,更换三代表皮生长因子抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI)后患者临床症状好转,胸水消失,肺部结节影像评估为部分缓解及稳定。

We reported a male,64-year-old patient who suffered advanced lung adenocarcinoma admitted to The Fourth Hospital of Hebei Medical University.On April 22,2017,he was sent to our department due to cough and chest tightness.His chest CT revealed plenty of left pleural effusion.The pleural effusion cells biopsy reported malignancy,possibility of lung adenocarcinoma.Positiron emission tomography-computed tomography(PET-CT)showed slightly thickening of the left pleura,local pleural nodular abnormal glucose high metabolism.After thoracoscopic pleural biopsy,further diagnosis of cancer(considering pulmonary origin)was confirmed.The immune-cytology of pleural effusion also showed adenocarcinoma,considering the pulmonary origin.The gene analysis revealed EGFR 19del positive.So,he was given EGFR-TKI erlotinib regularly.After 14 months stable conditions,on June 30,2018,this patient was admitted to our hospital again,due to chest tightness.The pulmonary ultrasound showed big liquid dark area(about 10.1 cm diameter)in his left thoracic cavity.Immediately,a thoracic drainage tube was placed in,then from which about 700 mL of dark blood pleural effusion was induced out.The cytology analysis found cancer cells.And the gene test results T790M positive.So,the third-generation EGFR-TKI Osimertinib was administrated to him on July 9,2018.All patient’s clinical symptoms were disappeared and his condition was stable until now.