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題名 | Epidermal Growth Factor Receptor Tests for Differentiation of the Origin of Metastatic Adenocarcinoma of Mediastinal Lymph Nodes with an Unknown Primary Site=表皮生長因子受體測試用於鑑別診斷原發部位不明之轉移性縱隔腔淋巴結腺癌 |
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作者 | 陳盈潔; 劉佳鑫; 彭成立; 李耀豐; 張山岳; 簡志峰; | 書刊名 | 胸腔醫學 |
卷期 | 29:5 2014.10[民103.10] |
頁次 | 頁304-309 |
分類號 | 415.468 |
關鍵詞 | 腺癌; 縱膈腔淋巴結; 表皮生長因子受體; 艾瑞莎; Adenocarcinoma; Mediastinal lymph node; Epidermal growth factor receptor; Gefitinib; |
語文 | 英文(English) |
中文摘要 | 原發部位不明的轉移性縱隔腔線癌是很少見的。我們報告一個62歲男性的縱隔腫塊在兩年內從1.9公分增長至5.1公分。這位病患接受縱膈腔鏡腫瘤切片,病理檢查證實為轉移性腺癌。經過一系列檢查後,病患被診斷為原發部位不明的轉移性縱隔腔線癌。他的疾病分期被定為肺腺癌第三期(cT0N2M0, stage IIIA)。病患接受cisplatin加上vinorelbine組合之化學暨放射線治療,然而因為病患無法忍受其副作用,再經過兩次療程後終止治療。這位病患後來接受了gefitinib作為第二線治療,即使腫瘤樣本的表皮生長因子受體(EGFR)基因型經直接序列分析檢測為原株。在日後的檢驗中發現,病患接受gefitinib藥物治療之下,縱膈腔腫瘤消失不見。病患治療1年後停止gefitinib治療,但仍然維持在治療36個月後完全緩解。後續我們經即時聚合酶連鎖反應(Real-time PCR)的方式檢測,證實病患的表皮生長因子受體(EGFR)之外顯子19之氨基酸缺失(deletion)。 |
英文摘要 | Metastatic adenocarcinoma of mediastinal lymph nodes with an unknown origin is rare. We report a 62-year-old male with a mediastinal mass that grew from 1.9 to 5.1 cm in 2 years. The patient underwent mediastinoscopic tumor biopsy, and the pathological exam disclosed metastatic adenocarcinoma. The patient was diagnosed as having metastatic mediastinal adenocarcinoma of unknown origin after extensive examinations. His disease was hypothesized as adenocarcinoma of the lung with mediastinal lymph node metastasis of cT0N2M0 stage IIIA. Chemotherapy with a regimen of cisplatin and vinorelbine plus thoracic radiation therapy was administered; however, these treatments were terminated after 2 courses of chemotherapy because of intolerable side effects. The patient received gefitinib as a second-line treatment, although direct sequencing of a tumor sample revealed the presence of the wild-type epidermal growth factor receptor (EGFR) gene. Subsequent examinations revealed that the mass lesion had disappeared with gefitinib treatment. The patient discontinued gefitinib after 1 year of treatment and remained in complete remission 36 months thereafter. An exon 19 deletion in EGFR was confirmed by real-time polymerase chain reaction (real-time PCR) of the mediastinal lymph node. |
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