December 2012 Pulmonary Case of the Month: Applying Genetics

Lewis J. Wesselius, MD¹

Thomas D. Kummet, MD²

¹Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ

²Olympic Medical Cancer Center

Sequim, WA

History of Present Illness

A 65 year old woman presented to her physician in with upper abdominal pain in August, 2007.  A CT scan of the abdomen demonstrated no abnormalities in her abdomen, but a 3.7 x 2.4 cm mass in the left lower lobe was noted.

PMH, FH and SH

She has no significant prior medical history. She is a life-long nonsmoker. There is no significant family history

Physical Examination

Her physical examination is unremarkable.

Which of the following is true?

1. Lung cancer does not occur in nonsmokers
2. The lesion is likely a rounded pneumonia based on its size
3. A family history of lung cancer is not associated with an increase in lung cancer
4. Calcification of the mass usually indicates lung cancer
5. Adenocarcinoma is the most common lung cancer seen in nonsmokers

Reference as: Wesselius LJ, Kummet TD. December 2012 pulmonary case of the month: applying genetics. Southwest J Pulm Crit Care 2012;5:272-8. PDF

Comments

[Rick Robbins, M.D.]

This case presentation deals with adenocarcinoma of the lung and testing for genetic mutations. The College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP) published guidelines online April 3, 2013 in the journals of those associations — the Journal of Thoracic Oncology, the Archives of Pathology & Laboratory Medicine, and the Journal of Molecular Diagnostics. Testing for EGFR and ALK translocations should be obtained in patients with advanced-stage adenocarcinoma considered candidates for chemotherapy regardless of sex, race, smoking history, or other clinical risk factors. The results from these mutations should be used to guide therapy with the EGFR inhibitor erlotinib (Tarceva) and the ALK inhibitor crizotinib (Xalkori).