Diagnosis and treatment of primary pulmonary enteric adenocarcinoma: Report of Six cases

Table 1 Clinical features and chest computed tomography results of six patients with pulmonary enteric adenocarcinoma

Case	Gender	Age (yr)	Smoking history	Chief complaints	Lesion location	Mass size (cm)	Metastatic lymph node	Metastatic locations	Tumor stage	OS (mo)
1	Male	61	-	Weakness of left limb, numbness of left face	Posterior segment of RLL	3.6 × 2.8	Hilar and mediastinal	Intracranialregion	T2N2M1	Lost to follow-up
2	Female	73	-	A lung mass found by imaging studies with slightly cough	Posterior segment of LLL	2.8 × 1.5	-	-	T2N0M0	Lost to follow-up
3	Female	59	-	A lungmass found by imaging studies	LLL	1.3 × 0.6	-	-	T1N0M0	> 58
4	Female	64	-	Pain of right chest and back	RUL	2.1 × 2.0	Mediastinal	Right pleura	T1N2M1	Lost to follow-up
5	Female	59	-	Cough with fever	Bilateral	2.7 × 1.5	-	Intra-pulmonary	T4N0M1	> 9
6	Female	68	-	Cough,expect-ration, pain of left lower limb with difficult walking	RLL	6.7 × 5.4	Mediastinum	Intra-pulmonary + intracranialregion	T4N2M1	> 7

CT: Computed tomography; OS: Overall survival; RUL: Right upper lobe; RLL: Right lower lobe; LLL: Left lower lobe.

Table 2 Serum tumor markers of six patients with pulmonary enteric adenocarcinoma

Case	CEA (ng/mL)	CA199 (U/mL)	CA125 (U/mL)
1	33.5	40.8	33.5
2	2.4	5.8	7.4
3	1.7	2.6	9.3
4	509	132.6	217.8
5	2.7	243.6	13.7
6	1.1	1449.9	17

Table 3 Immunohistochemical results of six patients with pulmonary enteric adenocarcinoma

Case	CDX2	CK20	CK7	TTF-1	Napsin A	ALK-lung	Others
1	+	+	-	-	-	Not tested	Not tested
2	-	-	+	-	-	Not tested	SPA (-)
3	+	Not tested	-	-	Not tested	Not tested	CK19 (+), SPA (-)
4	+	+/-	+	-	-	-	p63 (-), CK5/6 (-), PAX8 (-)
5	+	Not tested	+	-	-	-	CD20 (-), MUC2 (-)
6	+	-	+	-	-	-	Ki-67 (low)

CDX2: Caudal type homeobox transcription factor 2; CK: Cytokeratin; TTF-1: Thyroid transcription factor-1; Napsin A: Novel aspartic proteinase of the pepsin family A; ALK: Anapastic lymphoma kinase; SPA: Staphylococal protein A; PAX8: Paired box gene 8; MUC2: Mucin 2; CD20: Cluster of differentiation 20; Ki-67: Antigen identified by monoclonal antibody Ki-67; p63: Protein 63.

Table 4 Genetic testing results of four patients with pulmonary enteric adenocarcinoma

Case	ALK	BRAF	BRCA1	BRCA2	EGFR	ERBB2	KRAS	ROS1	TMB (/Mb)
3	-	-	-	-	-	-	+	-	6.3
4	-	-	-	-	-	-	-	-	6.3
5	-	-	+	-	-	-	+	-	10.3
6	-	-	-	-	-	+	-	-	13.5

ALK: Anapastic lymphoma kinase; KRAS: V-Ki-ras2 Kirsten; BRAF: A gene that makes a protein called b-raf; BRCA: Breast cancer 1; EGFR: Epidermal growth factor receptor; ERBB2: V-erb-b2 avian erythroblastic leukemia viral oncogene homolog 2; ROS1: C-ros oncogene 1 receptor kinase; TMB: Tumor mutation burden.

Table 5 Treatment for six patients with pulmonary enteric adenocarcinoma

Case	Lesion location	Treatment
1	Posterior segment of RLL	Gamma knife for intracranial metastases, with 4 times of pemetrexed + cisplatin, 3 courses of ENDOSTAR, 30 times of radiotherapy, and tumor evaluation was PR; gamma knife again for new intracranial metastases on November 19, 2013
2	Posterior segment of LLL	No treatment
3	LLL	Surgical resection first, reoperation of the resection region because of relapse in September 2015, and no recurrence evidence
4	RUL	No treatment
5	Bilateral	TC chemotherapy and bevacizumab, tumor evaluation was SD
6	RLL	Gamma knife + chemotherapy (pemetrexed + carboplatin), tumor evaluation was SD

PR: Partial remission; TC: Paclitaxel-cisplatin; SD: Stable disease.