2023 Volume 63 Issue 7 Pages 977-982
Background. We encountered a case of epidermal growth factor receptor (EGFR) gene mutation-positive lung adenocarcinoma that recurred 16 years postoperatively with subcarinal lymph-node metastasis alone. Case. A 65-year-old woman developed dyspnea. On an examination at a local hospital, right pleural effusion was found on chest radiography, and computed tomography of the chest revealed a 3-cm lung tumor in the right upper lobe of the lung with dissemination. She was diagnosed with right lung cancer (cT3N1M1a stage IVa) and treated with gefitinib starting September 2005. Three months later, salvage surgery was performed because of dissolution of the pleural effusion and shrinkage of the primary lesion. Gefitinib was continued postoperatively, and there was no recurrence for several years. Sixteen years after the surgery, an elevation of tumor marker levels was observed, and a close examination revealed left breast cancer and an enlarged subcarinal lymph node. The left breast cancer was treated with left mastectomy, and simultaneously, the subcarinal lymph node was excised. The lymph node was histopathologically diagnosed as metastasis of the lung cancer that had been excised 16 years earlier. Postoperatively, afatinib was administered, and the patient has survived without recurrence for 1 year and 11 months since the surgery. Conclusion. There have been few reports of long-term gefitinib administration and lung cancer recurring 16 years postoperatively. Further research is necessary to identify factors indicative of resistance to treatment after long-term gefitinib administration.
