Navigating the Nuances of Combined Histology: Advanced-Staged Small Cell Carcinoma of the Lung-Navigating the Nuances of Combined Histology: Advanced-Staged Small Cell Carcinoma of the Lung PDF

Navigating the Nuances of Combined Histology: Advanced-Staged Small Cell Carcinoma of the Lung PDF

Pdf Summary

This case study details the diagnosis and management of A.B., a 67-year-old Hispanic woman presenting with right chest and back pain, shortness of breath, non-productive cough, and unintentional weight loss, alongside a history of hypertension, atrial fibrillation, hyperlipidemia, diabetes, hypothyroidism, and GERD. Imaging (PET/CT) revealed a suspicious right upper lobe lung mass with metastatic involvement including lymph nodes, thoracic vertebrae, and the liver; brain MRI showed no definitive metastasis. Biopsy confirmed combined histology lung cancer: small cell lung carcinoma (SCLC) plus adenocarcinoma (a non-small cell lung cancer, NSCLC) component, verified by immunohistochemistry. Due to insufficient tissue for molecular profiling, plasma-based liquid biopsy was performed, detecting sensitizing EGFR mutations (p.L858R and p.L838V) and TP53 mutations, suggesting more aggressive disease.<br /><br />Treatment combined carboplatin/etoposide chemotherapy (standard for SCLC) with osimertinib, an oral EGFR tyrosine kinase inhibitor (TKI) targeting the adenocarcinoma component. The patient experienced manageable side effects including anemia, fatigue, diarrhea, skin rash, and nail changes. A multidisciplinary thoracic oncology conference guided this approach, deciding against immunotherapy given risks with combined histology and osimertinib use. Supportive care included pain management with gabapentin, Norco, and fentanyl patch, as well as advanced care planning reflecting patient preferences.<br /><br />Follow-up imaging after four cycles showed partial treatment response with residual disease nodules and stable treated metastases. Key learning points emphasize the importance of recognizing combined SCLC/NSCLC histology due to impact on therapy, utilizing liquid biopsy when tissue is insufficient for molecular testing, and applying a multidisciplinary, patient-centered approach including early palliative care integration. This comprehensive management highlights tailored treatment strategies for advanced-stage lung cancer with complex pathology to optimize outcomes and quality of life.

Keywords

Combined small cell lung carcinoma

Adenocarcinoma

EGFR mutations

TP53 mutations

Liquid biopsy

Carboplatin/etoposide chemotherapy

Osimertinib

Multidisciplinary thoracic oncology

Advanced-stage lung cancer

Palliative care integration