[Advanced lung cancer with recurrence of liver and tracheal metastases responsive to multimodality therapy - a case report].

We report a case of advanced lung cancer with recurrence of liver and tracheal metastases that were responsive to multimodality therapy. The patient was a 77-year-old man who suffered from advanced lung cancer with chronic obstructive pulmonary disease (COPD) and alcohol-induced liver cirrhosis. The primary lung cancer was surgically resected. Eight months after resection of the primary lung cancer, a solitary liver tumor appeared and hepatic resection was performed. Histological findings showed that both the primary lung tumor and the solitary liver tumor were squamous cell carcinoma (SCC). Subsequently, he developed a recurrence in his trachea 8 months after hepatic resection. Radiotherapy, endobronchial argon plasma coagulation (APC), and systemic chemotherapy were administered. The tracheal tumor remained stable without any liver metastasis for 25 months.

Large-cell neuroendocrine carcinoma of lung with epidermal growth factor receptor (EGFR) gene mutation and co-expression of adenocarcinoma markers: a case report and review of the literature.

PURPOSE: A high rate of response to treatment with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) has been observed in certain patients (women, of East Asian ethnicity, with non-smoking history and adenocarcinoma histology) with mutations in exons 18 to 21 of the tyrosine kinase domain of EGFR. Some cases of high-grade neuroendocrine carcinoma of the lung harboring mutations have been sporadically reported. METHODS: We describe the case of a 78-year-old woman with large-cell neuroendocrine carcinoma of the lung, with mutation in exon 21 L858R and co-expression of adenocarcinoma markers. RESULTS: A mass (3.0 cm in diameter) was identified in the inferior lobe of the left lung, accompanied by metastases into ipsilateral mediastinal lymph nodes and elevations of serum pro-gastrin-releasing peptide and carcinoembryonic antigen. Initial transbronchial brushing cytology suggested high-grade neuroendocrine carcinoma favoring small-cell carcinoma in poorly smeared and degenerated preparations, and revealed exon 21 L858R mutation. Re-enlargement of the cancer and bone metastases was observed after chemotherapy, and further testing suggested large-cell neuroendocrine carcinoma with immunoreactivity to markers of primary lung adenocarcinoma and L858R mutation. High-grade neuroendocrine carcinoma with mutations in the tyrosine kinase domain of EGFR may be associated with adenocarcinoma, as reviewed from the literature and may also apply to our case. CONCLUSIONS: EGFR-TKI could provide better quality of life and survival in patients with advanced or relapsed high-grade neuroendocrine carcinoma with EGFR gene mutations. Further studies in this respect are warranted.

[HEART PAP (adapted-servo ventilation; ASV) is effective for the ventilation of chronic heart failure patient with Cheyne-Stokes respiration].

CASE REPORT: A 72-year-old man with chronic heart failure had received implantation with a pacemaker for type III sick sinus syndrome in 2002. Mixed type sleep apnea syndrome (SAS) was diagnosed in 2004, and continuous positive airway pressure (CPAP) treatment was started. However, CPAP use become gradually difficult over the following 2 years. Atrial flutter was detected in December, 2006 and his heart failure became exacerbated. Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) was additionally found by the examination of PSG at that time. It was thought that he could not adjust his breathing to CPAP ventilation, because of the heart failure exacerbation. We introduced the HEART PAP (Respironics Inc. Murrysville, PA, USA) which was an adaptive-servo ventilator (ASV) on March 9, 2007. Mask wearing improved, and Cheyne-Stokes respiration and night hypoxemia disappeared. He showed improvement in sleep parameters and did not show the heart failure exacerbation diminished. It was recognized that the ASV yielded not only improvement of the respiratory status of this patient with heart failure but also an improvement of the cardiac function. Therefore, we should consider ASV for CSR-CSA patient who does not respond well to CPAP.