ABSTRACT
Pulmonary mucinous adenocarcinoma is a subtype of lung adenocarcinoma, among which invasive mucinous adenocarcinoma (IMA) is the most common subtype and is easily misdiagnosed as pneumonia. Its etiology and pathogenesis are unclear and may be related to gene mutations and other factors. Due to its relative rarity and few related studies, guidelines do not provide advices on its treatment. KRAS mutations are common in IMA patients, and Sotorasib may be effective against KRAS G12C mutated IMA. NRG1 fusion is considered to be an important driver of IMA, and afatinib may be effective in treating IMA with NRG1 fusion/rearrangement. PD-L1 expression is very low in IMA patients, while B7-H3 expression is high, so B7-H3 may be a potential immunotherapeutic target.
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Adenosquamous carcinoma of the lung is a rare pathological type of non-small cell lung cancer. Adenosquamous carcinoma of the lung has a high degree of malignancy and poor clinical prognosis. Medical treatment plays an important role in patients who have lost the opportunity of operation or have recurrence and metastasis after operation. Platinum based chemotherapy is still the cornerstone of medical treatment. It is recommended that routine driver gene testing should be performed for patients with advanced lung adenosquamous carcinoma. For patients with sensitive driver genes, targeted therapy has a definite effect in some patients. Studies on markers related to immune checkpoint inhibitors suggest that patients with lung adenocarcinoma may benefit from immunotherapy, but there is still a lack of clinical practice data.
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Targeted therapy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs) has been the standard modality as first-line treatment of advanced EGFR-mutated non-small cell lung cancer (NSCLC). The third-generation EGFR-TKIs has been approved to overcome the EGFR T790M mutation in patients resistant to the first-or second-generation TKIs, which brings more survival benefits for patients with advanced NSCLC. Unfortunately, acquired resistance inevitably develops after application of approximately 10 months. Heterogeneities of the tumor determines the diversity of resistance. Mechanisms of resistance to the third-generation TKIs includs EGFR-dependent pathway (such as new EGFR mutations, T790M reduction/disappearance and EGFR amplification, etc.) and EGFR-independent pathway (such as bypass pathway activation and histological transformation, etc.). In this paper, we reviewed principle mechanisms of acquired resistance to third-generation EGFR-TKIs.
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung , Drug Therapy , Genetics , Pathology , Drug Resistance, Neoplasm , ErbB Receptors , Genetics , Metabolism , Lung Neoplasms , Drug Therapy , Genetics , Pathology , Protein Kinase Inhibitors , Pharmacology , Therapeutic Uses , Signal TransductionABSTRACT
OBJECTIVE To explore the clinical features for pulmonary cryptococcosis due to Cryptococcus neoformans,and to improve diagnosis and treatment of the disease.METHODS The clinical features of inpatients with pulmonary cryptococcosis were studied retrospectively.RESULTS There were nine cases of pulmonary cryptococcosis from 1999 to 2006 of all inpatients in our hospital.Mals 5(56%),females 4(44%),and 3 cases(33%) were more than 60 years old.Three cases(33%) were immunocompromised hosts,6 cases(67%) had clinical symptoms.Chest X-ray and computed tomography were various included single or poly patching or nodule shadows,some had cavity(33%) and some had pleural effusions(22%).Six cases had positive results with serum cryptococcal antigen test.All nine patients were treated with fluconazole and improved or cured.CONCLUSIONS Pulmonary cryptococcosis is seldom seen in clinic,it can be observed in humans with normal immune responses or immunocompromised hosts and has no significant clinic manifestations,serum cryptococcal antigen test is helpful,definitive diagnosis needs early lung biopsy.The therapeutic effect is well.
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Objective:To describe the clinical,radiological and pathological characteristics of idiopa-thic pulmonary haemosiderosis(IPH) in adults and to evaluate the methods of diagnosis and treatment.Methods:Two patients were successfully diagnosed and treated in our hospital and the literature on the subject was reviewed.Results:Two adult patients(19 and 34 years old) diagnosed in our hospital had 5 and 10 years of history of hemoptysis respectively,and chest CT showed bilateral diffuse alveolar opacities over mid and lower zones.Tests of antinuclear antibodies(ANAs),rheumatoid factor(RF),antineutrophilic cytopasmic antibodies(ANCA) and Anti-glomerular basement membrane(anti-GBM) antibody were negative.Haemosiderin-laden macrophages were found in bronchoalveolar lavage fluid(BALF) whose color was yellow.Microscopic examination of the lung tissue specimens obtained by transbronchial lung biopsy(TBLB) revealed hemorrhage and numerous hemosiderin-laden macrophages in the alveoli and no vasculitis or capillaritis were seen.These findings were consistent with a diagnosis of IPH.Steroid therapy had good effects.Conclusion:IPH is a diagnosis of exclusion of other causes of diffuse alveolar hemorrhage(DAH).IPH adults have relatively good drug responses and relatively good prognoses.
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To describe the clinical,radiological and pathological characteristics of idiopathic pulmonary alveolar proteinosis(I-PAP)and to evaluate the methods of diagnosis and treatment.Three patients were successfully diagnosed and treated in our hospital and the literature on the subject was reviewed.Three patients,two males and one female(mean age 46 years),were diagnosed averagely in 4 months.Two severe patients presented with progressive dyspnea and type I respiratory failure,and one mild patient only with dry cough and hypoxemia.Chest X-ray radiographs all showed perihilar "butterfly" shadow and chest CT scans showed diffused ground-glass opacities(GGO),typically with "map" changes and "crazy paving" patterns.All the patients underwent bronchoscope,branchoalveolar lavage fluid(BALF)had grossly opaque and/or milky appearance and its sediment was periodic acid-Schiff stain positive.Transbronchoscopic lung biopsy(TBLB)specimens were obtained and under light microscopy alveoli and some of the small bronchioles were filled with eosinophilic proteinaceous material with needle-like clefts.By electron microscopy numerous cellular debris and extracellular multilamellated bodies were found.Two severe patients were successfully treated with sequential whole-lung lavage and one required repeated lavages.I-PAP is rare and prone to be misdiagnosed.The radiological features may indicate the diagnosis and examinations of TBLB and BALF can make the accurate diagnosis.Whole-lung lavage is the most effective therapy by now and granulocyte-macrophage colony-stimulating factor(GM-CSF)may be beneficial in some patients.
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OBJECTIVE:To summarize the clinical effect of compound glycyrrhizin(CG)on SARS.METHODS:The clin?ical data of73patients with clinically diagnosed SARS(37cases were treated by CG)were prospectively analysed.RESULTS:After CG treatment,the symptoms of dry cough,chest distress and dyspnea improved quickly and the elevated serum level of aminotransferase decreased.The maximal dosages of corticosteroids used in CG group and control group were(354.3?219.8)mg/d and(430?262.6)mg/d,respectively.The average time to occurrence of antibody,duration for reduction of corticosteroid dosage and duration of hospital stay were shorter in CG group than those in control group.There was no significant difference in titer value of antibody between two groups.CG had little effects on WBC,blood sugar and electrolytes.CONCLUSION:CG may be a promising drug against SARS with less side effect.
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OBJECTIVE:To summerize the characteristics and variability of chest X-ray manifestations in SARS patients treated with compound glycyrrhizin.METHODS:60cases of SARS were equally divided into2groups:groupⅠreceiving compound glycyrrhizin,groupⅡ(as control)receiving conventional treatment.The appearing time,site,scope and dynamic changes of the pulmonary lesions on chest radiograms were compared between2groups.RESULTS:The average period from peak to50%improvement of lesion in X-ray manifestations was shorter in groupⅠthan that in groupⅡ.In restoration stage,more patients had their X-ray findings absorbed in groupⅠcompared with the patients in groupⅡ.Compound glycyrrhizin had little influence on WBC,blood sugar and electrolytes.CONCLUSION:Glycyrrhizin may be a promising drug against SARS with less side effects.