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Case Studies | Oncology Science | India | Volume 12 Issue 6, June 2023
Extensively Metastaticlung Carcinoma without Any Actionable Mutation in a 20 year Old Nonsmoker Adolescent Male - A Case Report
Banerjee Debanti | Parikh Sonia K | Panchal Harsha P | Patel Apurva A
Abstract: Lung cancer is the second most common cancer in world and it is one of the leading causes of cancer death worldwide1. It is the most common cancer among male. Adenocarcinoma is the commonest type of lung cancer2. Median age of lung cancer diagnosis 65 years or more. Incidence of lung cancer below 40 years is less common3. Here we report a case of extensively metastatic adenocarcinoma of lung in a 20 years old non smoker male. This 20 years non smoker male without any comorbidity and significant family history, presented to Neurosurgery Department with complaint of headache and vomiting for 4 - 5 days. He was evaluated with plain and contrast enhanced MRI Brain which revealed well circumscribed soft tissue lesion in right occipital region and few small well defined heterogeneously enhancing lesion involving left temporal lobe, right cerebellum, vermis and left parietal lobe. He underwent craniotomy and excision of right occipital lesion. . Histopathology showed poorly differentiated malignant tumour, possibility of either metastatic carcinoma or malignant meningioma, grade 3. Immunohistochemistry was suggestive of metastatic adenocarcinoma, primary from lung. Whole body FDG PET CT scan showed FDG avid well to ill defined extensive soft tissue density lesion involving bilateral lung fields, largest in left infra hilar region associated with FDG avid mediastinal lymphadenopathy and metabolically active periportal, peripancreatic and pelvic lymphadenopathy, FDG avid hypodense lesion measuring in segment V and VI of liver and multiple FDG avid bony lytic lesion. He received whole brain radiation. Then patient was referred department of Medical Oncology for systemic therapy. Next generation sequencing (NGS) on tissue block did not show any actionable mutation. PDL1 testing by immuno histochemistry done by SP263 showed Tumour Proportion Score (TPS) score 28 - 30%. As patient could not afford immunotherapy, he was treated with Platinum based combination chemotherapy with Zoledronic Acid. After 4 cycles of chemotherapy CECT Brain, thorax, abdomen and pelvis was done. It showed significant regression of primary lesions and metastases. In view of very good response and good tolerance two more cycles of same chemotherapy then Pemetrexed based maintenance therapy was planned for him. Incidence of lung cancer in young adults is quite rare. Most of the patients are asymptomatic initially and because of low suspicion of lung cancer in this age group, diagnosis often gets delayed and patients may present in advanced stage. Genetic factors may have role in development of lung cancer in this patient population. In this case patient was non smoker and did not have any significant family history and history of pre existingpulmonaryaetiology. Because of the rarity of lung cancer in young population, underlying risk factors could not be studied. International multi institution based studies are needed to identify risk factors of young lung cancer.
Keywords: lung cancer, adolescent male, 20 years, adenocarcinoma, chemotherapy
Edition: Volume 12 Issue 6, June 2023,
Pages: 1225 - 1228