Female genital tract metastasis of lung adenocarcinoma with EGFR mutations: Report of two cases

BACKGROUND The female genital tract is an uncommon site of involvement for extra-genital malignancies. Ovarian metastases have been described as disseminations of lung adenocarcinoma;rare cases of secondary localizations in the cervix, adnexa, and vagina have also been reported in the literature. Here, we report two cases of advanced lung adenocarcinoma with female genital tract metastasis. CASE SUMMARY The first case was a 41-year-old woman with stage IV lung adenocarcinoma metastasizing to the cervix. Immunohistochemistry of the cervical biopsy specimen revealed thyroid transcription factor (TTF)-1(+), cytokeratin (CK)-7(+), and (CK)-20(-). Gene mutational analysis showed epidermal growth factor receptor (EGFR) L858R mutation in exon 21. She had a positive response to gefitinib, for both the pulmonary mass and cervical neoplasm. The second case was a 29-year-old woman who was diagnosed with stage IV lung adenocarcinoma with EGFR mutation. After 12 mo of treatment with icotinib, ovarian biopsy showed adenocarcinoma with CDX2(-), TTF-1(+++), PAX8(-), CK- 7(+++), CK-20(++), and Ki67(15%+), accompanied with EGFR 19-del mutation and T790M mutation. CONCLUSION Immunohistochemistry and gene mutational testing have greatly helped in locating the initial tumor site when both pulmonary and female genital tract neoplasms exist.

Hemorrhagic fever with renal syndrome complicated with aortic dissection:A case report

BACKGROUND Hemorrhagic fever with renal syndrome is caused by hantaviruses presenting with high fever,hemorrhage,and acute kidney injury.Microvascular injury and hemorrhage in mucus were often observed in patients with hantavirus infection.Infection with bacterial and virus related aortic aneurysm or dissection occurs sporadically.Here,we report a previously unreported case of hemorrhagic fever with concurrent aortic dissection.CASE SUMMARY A 56-year-old man complained of high fever and generalized body ache,with decreased platelet counts of 10×10^9/L and acute kidney injury.The enzymelinked immunosorbent assays test for immunoglobulin M and immunoglobulin G hantavirus-specific antibodies were both positive.During the convalescent period,he complained sudden onset acute chest pain radiating to the back,and the computed tomography angiography revealed an aortic dissection of the descending aorta extending to iliac artery.He was diagnosed with hemorrhagic fever with renal syndrome and Stanford B aortic dissection.The patient recovered completely after surgery with other support treatments.CONCLUSION Hemorrhagic fever with renal syndrome complicated with aortic dissection is rare and a difficult clinical condition.Hantavirus infection not only causes microvascular damage presenting with hemorrhage but may be risk factor for acute macrovascular detriment.A causal relationship has yet to be confirmed.

Treatment failure in a patient infected with Listeria sepsis combined with latent meningitis:A case report

BACKGROUND Listeria is a food-borne disease,which is rarely prevalent in the normal population;it mostly occurs in pregnant women,newborns,immunodeficiency patients,and the elderly.The main manifestations of this disease in patients include sepsis,meningitis,etc,and the mortality rate remains high,although the onset of meningitis is relatively insidious.CASE SUMMARY A 75-year-old man presented with a fever for 1 wk and was admitted to the hospital for diagnosis and management of a lung infection.His condition improved after receiving anti-infective treatment for 2 wk.However,soon after he was discharged from the hospital,he developed fever again,and gradually developed various neurological symptoms,impaired consciousness,and stiff neck.Thereafter,through the cerebrospinal fluid metagenomic testing and blood culture,the patient was diagnosed with Listeria monocytogenes meningitis and sepsis.The patient died after being given active treatment,which included penicillin application and invasive respiratory support.CONCLUSION This case highlights the ultimate importance of early identification and timely application of the various sensitive antibiotics,such as penicillin,vancomycin,meropenem,etc.Therefore,for high-risk populations with unknown causes of fever,multiple blood cultures,timely cerebrospinal fluid examination,and metagenomic detection technology can assist in confirming the diagnosis quickly,thereby guiding the proper application of antibiotics and improving the prognosis.

Ipsilateral breast metastasis from lung adenocarcinoma harboring anaplastic lymphoma kinase or ROS1 rearrangement and significant response after targeted therapy: report of two cases

To the Editor:A 43-year-old female patient was admitted to our department for a 6-month-history of paroxysmal cough in July 2013.She was diagnosed with right lower lung adenocarcinoma(cT2aN3M1b,stage IV,anaplastic lymphoma kinase[ALK]+)with bone metastasis in other hospital and came to participate a phase Ⅲ trial of crizotinib(No.NCT01639001).