Retroperitoneal Metastasis, with Marked Fibrosis, of Lung Adenocarcinoma after Afatinib Treatment: An Autopsy Case Report

Hiroki Ota; Tomohiro Ota; Eriko Narisawa; Hideyuki Chiba; Hiroshi Nakayama; Yoko Tsukumo; Atsuhiko Sakamoto; Naoko Honma

doi:10.2169/internalmedicine.4869-20

CASE REPORTS

Retroperitoneal Metastasis, with Marked Fibrosis, of Lung Adenocarcinoma after Afatinib Treatment: An Autopsy Case Report

Hiroki Ota, Tomohiro Ota, Eriko Narisawa, Hideyuki Chiba, Hiroshi Nakayama, Yoko Tsukumo, Atsuhiko Sakamoto, Naoko Honma

Author information

Hiroki Ota
Department of Respiratory Medicine, Japanese Red Cross Society, Omori Red Cross Hospital, Japan
Tomohiro Ota
Department of Respiratory Medicine, Japanese Red Cross Society, Omori Red Cross Hospital, Japan
Eriko Narisawa
Department of Respiratory Medicine, Japanese Red Cross Society, Omori Red Cross Hospital, Japan
Hideyuki Chiba
Department of Gastroenterology, Japanese Red Cross Society, Omori Red Cross Hospital, Japan
Hiroshi Nakayama
Department of Surgery, Japanese Red Cross Society, Omori Red Cross Hospital, Japan
Yoko Tsukumo
Department of Pathology, Japanese Red Cross Society, Omori Red Cross Hospital, Japan
Atsuhiko Sakamoto
Department of Pathology, Japanese Red Cross Society, Omori Red Cross Hospital, Japan
Naoko Honma
Department of Pathology, Toho University School of Medicine, Japan

Keywords: lung adenocarcinoma, retroperitoneal metastasis, retroperitoneal fibrosis, hydronephrosis, EGFR mutation, transformation

JOURNAL OPEN ACCESS

2020 Volume 59 Issue 22 Pages 2915-2919

DOI https://doi.org/10.2169/internalmedicine.4869-20

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Details

Abstract

A 73-year-old woman was admitted to our hospital for treatment of vomiting. Four months previously, she had been diagnosed with lung adenocarcinoma (cT3N3M1a stage IVA) and started receiving afatinib as first-line treatment. On admission, the primary tumor had shrunk, but abdominal computed tomography revealed a new retroperitoneal lesion causing duodenal obstruction and hydronephrosis. She underwent gastrojejunostomy, and a biopsy of the peritoneum revealed adenocarcinoma. She was treated with second-line chemotherapy but developed cerebral infarction and died 104 days after admission. An autopsy revealed marked fibrosis with scattered tumor cells in the retroperitoneum. The underlying mechanism of the metastasis is discussed.

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