Volume 140, Issue 5, Pages (November 2011)

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Volume 140, Issue 5, Pages 1354-1356 (November 2011) Long-term Disease-Free Survival of a Patient With Synchronous Bilateral Lung Adenocarcinoma Displaying Different EGFR and C-MYC Molecular Characteristics Paolo Graziano, MD, Giuseppe Cardillo, MD, Andrea Mancuso, MD, Gregorino Paone, MD, Rita Gasbarra, BScD, Filippo De Marinis, MD, Alvaro Leone, BScD CHEST Volume 140, Issue 5, Pages 1354-1356 (November 2011) DOI: 10.1378/chest.10-2276 Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 1 Radiologic and histologic images. A, B, PET-CT scan showing different uptake of the lesions in the left (A) and right (B) upper lobes. C, Moderately differentiated mixed-type adenocarcinoma showing angioinvasiveness (arrow) with acinar and papillary features (hematoxylin-eosin, original magnification ×20). D, Well-differentiated, minimally invasive adenocarcinoma with predominant bronchioloalveolar growth (hematoxylin-eosin, original magnification ×20). CHEST 2011 140, 1354-1356DOI: (10.1378/chest.10-2276) Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 2 Molecular alterations. A, Canonical EGFR exon 19 microdeletion (746-750delELREA) detected by direct Sanger sequencing in the left-upper-lobe (LUL) lesion. B, EGFR wild-type status of the right-upper-lobe (RUL) lesion. C, EGFR amplification in the LUL lesion identified by fluorescence in situ hybridization analysis with EGFR/CEP7 dual probe showing a ratio of EGFR gene (red signal) to CEP7 (green signal) of more than five copies in three of five shown nuclei. D, Low EGFR polysomy (1:1 EGFR/CEP7 ratio and four chromosomes or fewer, seven copies per nucleus) in the RUL lesion. E, C-MYC amplification in the LUL lesion detected with C-MYC/CEP8 dual probe showing a ratio of C-MYC gene (red signal) to CEP8 (aqua) of more than three copies in all shown nuclei. F, Low polysomy (1:1 C-MYC/CEP8 ratio and four chromosomes or fewer, eight copies per nucleus) in the RUL lesion. CHEST 2011 140, 1354-1356DOI: (10.1378/chest.10-2276) Copyright © 2011 The American College of Chest Physicians Terms and Conditions