Background: Lung adenocarcinoma with miliary metastasis in both lungs is easily misdiagnosed. The aim of this study is to investigate the clinical features of lung adenocarcinoma with miliary metastases in both lungs and to improve the clinician's understanding of the disease.
Methods: The clinical manifestation, radiology and pathology were analyzed in one patient with miliary intrapulmonary carcinomatosis in Affiliated Hospital of Zunyi Medical University. A review of literature was performed with "miliary intrapulmonary carcinomatosis", "lung cancer miliary", "pulmonary nodule, lung cancer" and "EGFR miliary" as key words in PubMed, Wangfang datebase and CNKI.
Results: The patient was a 52 year-old woman with a history of productive cough for 2 months, which aggraveted with shortness of breath for 1 month. Her computed tomography of chest showed diffuse military nodules distributed at bilateral lungs. Computed tomography (CT)-guided needle biopsy of the left lung revealed lung adenocarcinoma and epidermal growth factor receptor (EGFR) exon 21 L858R mutation. The patient was treated with gefitinib 250 mg per day. The chest CT was reviewed several times during this period, which shows the double lung nodules were reduced. The patient is generally in good condition and her symptoms have improved. By literature review, we found relevant 7 Chinese articles and 56 English articles, a total of 16 cases have been reported. 17 patients were lung adenocarcinoma, 2 patients did not describe whether to detect EGFR gene mutations, 1 patient did not have EGFR gene mutation; 10 patients were EGFR exon 19 deletion, 1 patient was ALK positive, 1 patient was EGFR exon 21L858R mutation, 2 patients were EGFR exon 20 insertion.
Conclusions: Lung adenocarcinoma with miliary metastasis in both lungs is a rare phenomenon. We should pay attention to the performance to avoid misdiagnosis. Most of the adenocarcinoma subtypes have EGFR mutations, and EGFR-tyrosine kinase inhibitors (EGFR-TKIs) are the preferred treatment choice for this type of patients.
【中文题目：双肺粟粒样转移的肺腺癌1例报道 并文献复习】 【中文摘要：背景与目的 以双肺粟粒样转移为表现的肺腺癌临床表现特殊，极易误诊。本研究探讨双肺粟粒样转移的肺腺癌的临床特征，以提高临床医师对该病的认识。方法 回顾性分析遵义医科大学附属医院收治的1例经病理确诊的双肺粟粒样转移的肺腺癌患者，以“粟粒样，肺癌”、“肺癌，双肺转移”和“肺癌，结节”为检索词检索万方数据库和中国期刊网全文数据库（CNKI），以“miliary intrapulmonary carcinomatosis”、“lung cancer miliary”、“pulmonary nodule, lung cancer”和“EGFR, miliary”为检索词检索PubMed数据库，检索时间1947年1月1日-2019年5月30日。结果 患者女，52岁，因“咳嗽、咳痰2月，气促1月”于我院就诊，胸部计算机断层扫描（computed tomography, CT）提示双肺弥漫结节，经皮肺穿刺活检术后病理诊断肺腺癌、表皮生长因子受体（epidermal growth factor receptor, EGFR）外显子21 L858R突变。患者经口服吉非替尼治疗1个月后病情明显好转，多次复查胸部CT提示双肺结节较前减少。共检索出相关中文文献7篇，英文文献56篇，经阅读除外资料不详者及无病理诊断结果的文献，共报道16例，结合本例，对17例汇总分析。17例肺腺癌有2例未描述是否进行EGFR基因检测，15例EGFR基因检测中1例无突变，10例为19外显子缺失，1例ALK阳性，1例EGFR外显子21 L858R突变，2例为外显子20插入。结论 以双肺粟粒样转移改变为特征的肺腺癌临床罕见，属肺腺癌亚型，应重视其表现以避免误诊。该腺癌亚型大多有EGFR突变，EGFR酪氨酸激酶抑制剂（EGFR-tyrosine kinase inhibitors, EGFR-TKIs）是这类患者的首选治疗。】 【中文关键词：EGFR突变；肺粟粒样转移；肺肿瘤；肺腺癌】.
Keywords: EGFR mutations; Lung adenocarcinoma; Lung miliary metastases; Lung neoplasms.