case_images: PMC6287414_01
case_images: Computed tomography (CT) scans after different therapies.. Notes: (A) Before any treatment; (B) 1 day before icotinib treatment; (C) CT of the chest showing a slight increase in tumor volume after 1 month of icotinib; (D) before afatinib treatment; (E) CT of the chest showing stable disease after 1 month of afatinib.
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case_images: PMC6287414_01_ott-11-8705Fig1.jpg
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case_images: CT scan identified several solitary lumps in the left lower lobe, and the patient also had mediastinal lymphadenopathy and pleural metastasis (Figure 1). A month later, a CT scan revealed a slight enlargement of the primary mass and multiple nodules in the lung compared with the day before the icotinib treatment (Figure 1B and C). After 1 month of the afatinib therapy, a repeated CT scan demonstrated a slight decreased tumor size in the left lobe (Figure 1D and E).
case_images: Immunohistochemistry (IHC) of biopsy specimen.. Notes: (A) A high-power magnification of the tumor specimen shows squamous carcinoma (200x). IHC analysis revealed that the lung tumor cells were positive for CK5/6 (B), P40 (C), and P63 (D); 200x.
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case_images: PMC6287414_01_ott-11-8705Fig2.jpg
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case_images: An immunohistochemistry (IHC) examination of the transbronchial needle aspiration biopsy specimen revealed that the tumor cells exhibited a strong positive staining for CK5/6, P40, and P63 (Figure 2).
case_images: Molecular analysis of gene detection.. Notes: (A) Tissue biopsy showed a deletion mutation in EGFR exon 19 by amplification refractory mutation system PCR. (B) The Integrative Genomics Viewer snapshot of HER2 S310Y by next-generation sequencing.
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case_images: PMC6287414_01_ott-11-8705Fig3.jpg
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case_images: Then, amplification refractory mutation system PCR, to assess the tissue biopsy for EGFR exon 18-21, showed a deletion mutation in exon 19 of EGFR (Figure 3), prompting the initiation of the EGFR-inhibitor icotinib (125 mg tid). The result showed that the patient had HER2 exon 8 S310Y mutation (c.929C>A) with an allelic fraction of 42.49% and wild-type EGFR (Figure 3B).