Miliary Never-Smoking Adenocarcinoma of the Lung: Strong Association with Epidermal Growth Factor Receptor Exon 19 Deletion Eckart Laack, MD, Ronald.

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Miliary Never-Smoking Adenocarcinoma of the Lung: Strong Association with Epidermal Growth Factor Receptor Exon 19 Deletion Eckart Laack, MD, Ronald Simon, PhD, Marc Regier, MD, Birte Andritzky, MD, Pierre Tennstedt, PhD, Christian Habermann, MD, Christoph zur Verth, MD, Ina Thöm, MD, Tobias Grob, MD, Guido Sauter, MD, Carsten Bokemeyer, MD Journal of Thoracic Oncology Volume 6, Issue 1, Pages 199-202 (January 2011) DOI: 10.1097/JTO.0b013e3181fb7cf1 Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Epidermal growth factor receptor (EGFR) sequence analysis results of exon 19. A and B, EGFR wild-type sequence by forward and reverse sequencing. C–E, Sequence analysis results of cases 1, 2, 3, 4, and 5 by forward (C, D, and G) or reverse (E and F) sequencing. Case 1: c.2238_2252del; case 2: c.2237G>A and c.2238_2252del; case 3: c.2238_2252del; case 4: c.2238_2252del; and case 5: c.2238_2252del (an arrow point out the mutation for each case). Journal of Thoracic Oncology 2011 6, 199-202DOI: (10.1097/JTO.0b013e3181fb7cf1) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Transverse computed tomography (CT) images (window center/window width: 450/1800 Houndsfield units) represents the three patients before treatment (A: case 1, C: case 2, and E: case 3) and horizontally corresponding images of the same patients (B: 7 weeks later, D: 8 weeks later, and F: 17 weeks later) after treatment with EGFR tyrosine kinase inhibitor erlotinib. The right column of images demonstrates a clearly visible reduction of metastasis in size and number. Journal of Thoracic Oncology 2011 6, 199-202DOI: (10.1097/JTO.0b013e3181fb7cf1) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Case 2: conventional chest x-rays prior (A) and 4 weeks posttreatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor erlotinib (B) illustrate not only a fulminant decrease of the miliary lung metastases but also a reduction of size of the primary tumor side of the right upper lobe (arrows) and of the pleural effusion. Journal of Thoracic Oncology 2011 6, 199-202DOI: (10.1097/JTO.0b013e3181fb7cf1) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions