Small Cell Lung Cancer Derived from Adenocarcinoma with Mutant Epidermal Growth Factor Receptor Provides a Signature of Transcriptional Alteration in Tumor Cells

Yuki Tenjin; Kazuyoshi Nakamura; Shiho Ishizuka; Koichi Saruwatari; Ryo Sato; Yusuke Tomita; Sho Saeki; Hidenori Ichiyasu; Kazuhiko Fujii; Takaaki Ito; Takuro Sakagami

doi:10.2169/internalmedicine.2988-19

CASE REPORTS

Small Cell Lung Cancer Derived from Adenocarcinoma with Mutant Epidermal Growth Factor Receptor Provides a Signature of Transcriptional Alteration in Tumor Cells

Yuki Tenjin, Kazuyoshi Nakamura, Shiho Ishizuka, Koichi Saruwatari, Ryo Sato, Yusuke Tomita, Sho Saeki, Hidenori Ichiyasu, Kazuhiko Fujii, Takaaki Ito, Takuro Sakagami

Author information

Yuki Tenjin
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Departments of Pathology and Experimental Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Kazuyoshi Nakamura
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Shiho Ishizuka
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Koichi Saruwatari
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Ryo Sato
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Yusuke Tomita
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Sho Saeki
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Hidenori Ichiyasu
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Kazuhiko Fujii
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Takaaki Ito
Departments of Pathology and Experimental Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan
Takuro Sakagami
Department of Respiratory Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Japan

Keywords: small cell lung cancer, epidermal growth factor receptor, adenocarcinoma, transcriptional alteration, acquired drug resistance

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 22 Pages 3261-3265

DOI https://doi.org/10.2169/internalmedicine.2988-19

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Abstract

Small cell lung cancer (SCLC) transformation of epidermal growth factor receptor (EGFR) mutant adenocarcinoma (ADC) during EGFR tyrosine kinase inhibitor (TKI) treatment is an example of a rare subset of acquired drug resistance. We herein report the case of a 75-year-old man treated with afatinib who was then diagnosed with SCLC transformation. After two years of successful treatment with afatinib, the tumor relapsed, and a re-biopsy revealed SCLC harboring EGFR exon 19 deletion. We encountered a case of transcriptional alteration, potentially important for SCLC transformation of EGFR mutant lung ADC, that was recognized via the expression of NOTCH, ASCL1 and RB1 on immunohistochemical staining.

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