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CASE REPORT SPRINGER LUNG CANCER INTERNATIONAL PRECEPTORSHIP VIENNA Stefan Jungbauer, Universital hospital of Erlangen, Department of internal medicine 1 01
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Anamnesis 45year old female patient presented to an externe clinic with dyspnoe for 5 days thoracic pain on the right side for four weeks no haemoptysis risk factor: no smoking no weight loss, fever or night sweat medication: ibuprofen as needed, Candesartan 8mg 1/2-0-0 02
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physical examination well-developed, well-nourished woman chest: decreased breath sound on the right heart: notable for a normal S1, S2 without frequent extrasystole and no rubs, murmurs or gallops. abdomen: soft, no pain, normoactive bowel sounds in all 4 quadrants. extremities: no edema. neurologic exam: Cranial nerves II through XII are grossly intact. Strength is 5 out of 5 throughout with 2+ reflexes. Sensation to fine touch is intact throughout. The patient is alert and oriented x 3. 03
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Differential diagnosis Respiratory infection with pleuritis Pulmonary embolism Cardiac insufficiency Cardiac infarction Trauma Etc. 04
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Lab –Blood count was normal –Electrolytes, kreatinine, liver function tests and CRP were normal –Troponine was normal –Pathologic LDH 410+ (<214) D-dimere 1,39+ (<0,5µg/ml)
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Further tests –ECG: was normal –Chest X-ray: huge pleural effusion on the right side –Echocardiography: sinus rhythm, no abnormality of repolarisation, indifferent type, PQ<0,2sec, QRS<0,1sec –Cardiac ultrasound: normal right and left ventricular function, ejection fraction 60%, valve function was normal, no pericardial effusion NEXT step?
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CT scan Date: Subject: Content:
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Thoracentesis pleural effusion on the right side thoracentesis was performed LDH and protein were elevated exudate pathology: TTF1 positive adenocarcinoma 08
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Bronchoscopy Endobronchial ultrasound with transbronchial aspiration of lymph nodes postion 12R and 7 No endobronchial tumor lesions
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Pathology Strong positivity for CK7 and TTF1; negativitaty for CK5, synaptophysin primary adenocarcinoma of the lung EGFR-mutation analysis of the exons 18-21: –Exon 19 deletion was found No EML-4ALK translocation
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P Further medical history Staging: cT3N2M1a (PLEUR) Afatinib-therapy was started with 40mg per day (19/02/2014) Pleurodesis with talc was performed 2/2014 Staging was performed by CT scan 08/2015: progress with pleural effusion occurred Higher dosage of Afatinib (50mg per day) was tried because of very good therapy tolerance and no side effects under 40mg 09/2015: Systemic therapy with cisplatin 75mg/m 2 and pemetrexed 500mg/m 2 was started (6 bouts of chemotherapy) Maintenance therapy with pemetrexed 500mg/m 2 since 1/2016 liquid biopsy for T790M mutation was negative
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