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Transcript of EGFR ˘ˇˆ˙˝˛˚˜ !# 1 - 聖マリアンナ医科大学...
���� ����������Vol. 33, pp. 529�535, 2005
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Table 1. Laboratory Data
Fig. 1. Chest radiograph on admission showed irregu-
lar-shaped mass lesion in the right middle lung
field and multiple small nodular shadows in
bilateral lung fields.
Fig. 2. Chest CT scan on admission showed irregu-
lar-shaped mass lesion with pleural indentation
in the right S6 and multiple small nodular
shadows in bilateral lung fields.
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�������� ��������� ��EBUS ����� ����������������� ����������� �!��Fig. 3A�� "�� ����� #��$�%&'()����� �** !+����,�-.� /0$1��2���������� 3 456�7�!4�� ����������5�89:0���;��<� �Fig. 3B�� �0���=>�?���@*A=>�B �� ��CD��� EE�F0��G+H��G+IFJ�����K���5���=�L5��M�N����Fig. 4�� O�� AP�!QR5 genomic DNA
�ST�� UV'W)X�YZ["� EGFR 0exon18�19�21 �\!]#?^_��[`�a�
abcde�f$����� exon21 � heterozy-gous missense mutation �L858R����� �Fig. 5��gL� ]#?^_�\!�%h0i)jkl�]#?^_mn�d0o�� !+�o�&p'1011 p�� /0$� (q>r0st T4N3M1�stage IV�N�� uv� 7B)wJ��M�Lx+y*��z{|}M~���M~0+~,-*"��%�g !+�00� .��./LR���0�g��1g2�-�34��**�A�� 5�6�!O�� 30���Z)7$��+� %�8� 79���9��<� :4:�;��R+M:�<� (q�=�LR���>���5� ?�@�(q�h*"��A�B��� j��{��0CD�,���� ��� E�F�G¡Hy*� �;��I¢�<�F�� MS �Z{Z� [£�V¤0CD�Bg �� /0$� j��{��0CD�¥J�����y*,� 15K$��� ¦� XH§¨ �Fig. 6�LR�¦� CT© �Fig. 7����ª S60�L�EE«w�� M�N���O¬:���AP!�B:�;�O�PQ�®¯�!�� /0$� y*,� 5Y°$�� CYFRA 12.5 ng�ml,SLX 87.6 U�ml� CEA 11.7 ng�ml�!�P�R±���!�� -A���CD�²S�³´�Tµ��+ �Fig. 8��
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uv� ���¶��2��U" �EBUS� ����V·W�N�1�� �X¸�Y0@Z0�[� ¹@N�2�� ºZ�\g�0�����]»0^¼3�� ³
Fig. 3B. The EBUS image revealed heterogeneous
internal echoes and an irregular margin of the
lesion, with almost no vessels or bronchi within
the lesion.
Fig. 3A. The EBUS image revealed that the probe was
adjacent to the lesion because of drainage
bronchus obstruction.
Fig. 4. Histological examination of the lung tissues
obtained from TBLB biopsy with HE staining
showed adenocarcinoma cells ��100��
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����������� �3����������� ������������ EBUS � �!�"#�$� 1992%� Hurter �& 26'()� 19'(*+,&-.*/01234#���4�� 5�*$78�9:*�������;���<#�$� =>?@>AB&�����C1� 25D&�
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Fig. 5. Missense mutations in exon 21 of EGFR.
Fig. 6. Chest radiograph at 15 days after commence-
ment of gefitinib.
Note improvement of the mass lesion in right
middle lung fields and multiple small nodular
shadows in bilateral lung fields.
Fig. 7. Chest CT scan at 15 days after commencement
of gefitinib.
Note improvement of mass lesion in the right S6
and multiple small nodular shadows in bilateral
lung fields.
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���� EBUS ������������ ����������������� ���������������� �!"� #�$%&'�()�*$�()+�,� -��./�0!"1��2�3+45��!��� 6789���� EBUS �EBUS-GS� 4:��;�<�����6789���2������=>9?�����@�A�B�=>9?��C�!DEF()��!���4� EBUS-GS ��=>9?���4GHIJ����K�6789��L��MM� N���B���()�O���2�3+��������-�()45��!��� B�PQ� �R-� 10 mmS'��T����� 76�+U�1�����3+4���+�V����5�� T-�B�1���=>9?4�� ������WX�within� �� 87� �Y������� ���!Z�[����WX �adjacent to� �� 42� �Y��� "\#�]������^��$%_`a4&b������� 3�MM()�cd+ adjacentto +!H� eH1���fg���� hijkl���&b����$%_`a�*'Tm�()���� 3�n)�eH adjacent to �- within���3+4eH1���Yg�3+��!4H�
��!1��o��+pq-E�� :*� rc�s+,�t-�uv.�A/0+��/O12v.34'�!A4�5���Y�� 2004�� Lynch -� EGFR �w>8xhy9z�K�]D�{6O�|4/O12v.3�A��Y�}~�w�?������7����3+��V��6�� 8-�e�+� ��.)9�Y�rc�,�t-u�R 275#�}~�w�?:�v.4c�E� 25 #4;���� ;�#�d� 9#� EGFR {6O���]3!��+3�� 8#� EGFR {6O�|�<��4� A(�,;�# 7 #��EGFR{6O�|�<�-E!���+�V����� 8-�M��3� EGFR{6O�|� EGFR4 EGF�=��eH�"���TE� BE4>"����?�������3+����]H� B�����}~�w�?�e���Q2�@�TE�3+������}~�w�?4;�2��6=��|�� EGFR4�����2� EGFR ��A������+�V����� 3E-�3+eH� }~�w�?4;���"\#�]���� 3��A���]3��3+4��TE�� A(� Paez -�,�t-�u�R 119#�B�� 61�� *"� 58����Ct-���� EGFR w>8xhy9z�K�{6O���c��+3�� EGFR {6O�|�Du� ��� *"�� ,��R�E��F"<�-E� B�EGFR {6O�|��QGH O�Y�+I¡��G@GH O��Y�+�V����7�� M�Lynch -� EGFR {6O�|� 119�,�t-�u�R���� 2 �- 25 � exon �����-¢�+3�� �|4 16Y��4BE-�J� 18�-21 �Y��+�V��]H� "\#�]���w>8xhy9z���K� exon18�19�21����EGFR {6O�����+3�� exon21 � het-erozygous missense mutation �L858R� 4<�-E�� 3� L858 �8£¤¥£¤¦§�-¨lM�©�ª�KLTE���«M!¬®¯�Y�� B���� 3��K��|4 EGFR �°��'�!�±�7q���Y�d+pq-E�� SfeH� *"�����,��R��Y�"\#�}~�w�?�v.�Q4²/³N���+O���� P��}~�w�?�Q7��+3����� ´µ� Q75¶·R���4� ¸¹�ºS�Y��»�!�K�-�()�� »�!�T1��5���� U¼!v.��!4�� "\#�ed�$%
Fig. 8. Chest CT scan at 5 months after commencement
of gefitinib.
Note improvement of mass lesion in the right S6
and multiple small nodular shadows in bilateral
lung fields.
}~�w�?4�����Du� 1# 533
27
���������� � ������������� within�������� adjacent to ����� �!"#$� %&'(�)*+,�-./+� 012!�� EBUS-GS 3 45�#$6789� EGFR :;� <�=>-7$�0?@*� AB�,CDE:F@GH-�IJ@+�
� �
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bcde KLMN *534
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Abstract
A Case of Pulmonary adenocarcinoma with EGFR Mutation Diagnosed
by Endobronchial Ultrasonography with Guide Sheath
�EBUS-GS� Successfully Treated with Gefitinib.
Takeo Inoue1, Noriaki Kurimoto2, Miho Nakamura1, Masahiro Ohsige1,
Atsuko Ishida1, Junko Sagi1, Yoshitugu Fujita1, Yuka Matsuoka1,
Taeko Shirakawa1, Mamoru Tadokoro3, Teruomi Miyazawa1,
and Hiroaki Osada.2
A 79-year-old Japanese woman with no smoking habit was referred to our hospital complaining of
anterior chest pain. Chest CT showed a mass in the right middle lobe and multiple pulmonary nodules in
both lungs. For further examination, we performed transbronchial lung biopsy using endobronchial
ultrasonography with a guide sheath �EBUS-GS�� Biopsy specimens of the lung revealed adenocarcinoma,and she was diagnosed as lung cancer with multiple pulmonary metastases. We searched for the EGFR gene
mutations in one of the primary tumor specimens, and an exon 21 missense mutation �L858R� was detected.Subsequently, we initiated gefitinib, and it acted dramatically on both primary tumor and pulmonary
metastases. Since EGFR gene analysis needed a fair amount of tumor cells, it has been mainly analyzed by
surgically resected specimens. However, as EBUS-GS makes it possible to obtain biopsy specimens at better
site, it is expected that EGFR gene analysis will be performed with less invasive method using EBUS-GS.
1 Division of Respiratory and Infectious Disease, Department of Internal Medicine, St. Marianna University School
of Medicine
2 Department of Chest Surgery, St. Marianna University School of Medicine
3 Department of Diagnostic Pathology, St. Marianna University School of Medicine
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