title: Miliary never-smoking adenocarcinoma of the lung: strong association with epidermal growth factor receptor exon 19 deletion.
abstract: Miliary pattern of pulmonary metastases is a rarity in patients with lung cancer. We report five cases of patients with a never-smoking adenocarcinoma of the lung with such a pattern of metastases. In the tumor cells of all five patients, epidermal growth factor receptor (EGFR) mutation gene sequencing identified a deletion in exon 19 of the EGFR gene, and all five patients had a dramatic response to EGFR tyrosine kinase inhibitors. No echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) translocation was detected. We believe that the miliary never-soking adenocarcinoma of the lung is a distinct clinically relevant subgroup of the never-smoking non-small cell lung cancer. Physician should recognize this subgroup of patients with lung cancer when facing a picture of miliary pulmonary metastases in chest x-ray or computed tomography scan in patients with a history of never smoking and consider upfront therapy with EGFR tyrosine kinase inhibitors.
authors.affiliation: Ambulantes Krebszentrum Hamburg, Hamburg, Germany. laack@krebszentrum-hh.de
authors.forename: Eckart
authors.initials: E
authors.lastname: Laack
authors.forename: Ronald
authors.initials: R
authors.lastname: Simon
authors.forename: Marc
authors.initials: M
authors.lastname: Regier
authors.forename: Birte
authors.initials: B
authors.lastname: Andritzky
authors.forename: Pierre
authors.initials: P
authors.lastname: Tennstedt
authors.forename: Christian
authors.initials: C
authors.lastname: Habermann
authors.forename: Christoph Zur
authors.initials: CZ
authors.lastname: Verth
authors.forename: Ina
authors.initials: I
authors.lastname: Thöm
authors.forename: Tobias
authors.initials: T
authors.lastname: Grob
authors.forename: Guido
authors.initials: G
authors.lastname: Sauter
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000235:genetics / Q000556:secondary; D001932:Brain Neoplasms / Q000235:genetics / Q000556:secondary; D018267:Carcinoma, Acinar Cell / Q000235:genetics* / Q000556:secondary; D004273:DNA, Neoplasm / Q000235:genetics; D066246:ErbB Receptors / Q000235:genetics*; D005091:Exons / Q000235:genetics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D009367:Neoplasm Staging; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D016133:Polymerase Chain Reaction; D011379:Prognosis; D017384:Sequence Deletion; D012907:Smoking; D014178:Translocation, Genetic
chemical_list: D004273:DNA, Neoplasm; C522504:EML4-ALK fusion protein, human; D015514:Oncogene Proteins, Fusion; C512478:EGFR protein, human; D066246:ErbB Receptors