Diagnostic cytopathology · 2026
Pleural Fluid Cytology Detects Small Cell Carcinoma Transformation in EGFR-Mutant Lung Adenocarcinoma: A Case Report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Zhou Huijun, He Zhengyue, Wang Zhuo, Zhao Sihan, Zheng Chang, Liang Yanli, Liu Lianghua
Аннотация
BACKGROUND: Histological transformation of lung adenocarcinoma to small cell carcinoma is a rare but critical mechanism of acquired resistance to EGFR-TKIs.
CASE: A 65-year-old woman with EGFR-mutant lung adenocarcinoma developed new-onset massive pleural effusion after an initial partial response to icotinib. Pleural fluid cytology revealed tumor cells with high nuclear-to-cytoplasmic ratio, finely granular chromatin, and nuclear molding, features suggestive of small cell carcinoma. Cell block immunohistochemistry confirmed small cell carcinoma (CD56+, Syn+, TTF-1+). Molecular testing demonstrated persistence of the original EGFR exon 19 deletion mutation, and single-cell sequencing supported clonal origin.
CONCLUSION: Integrated cytological and molecular analysis of pleural fluid can provide compelling evidence supporting small cell transformation in EGFR-mutant lung adenocarcinoma. The shared EGFR mutation between the primary and transformed tumors is consistent with clonal evolution. This minimally invasive approach offers a practical alternative to tissue re-biopsy for monitoring acquired resistance to EGFR-TKIs.
CASE: A 65-year-old woman with EGFR-mutant lung adenocarcinoma developed new-onset massive pleural effusion after an initial partial response to icotinib. Pleural fluid cytology revealed tumor cells with high nuclear-to-cytoplasmic ratio, finely granular chromatin, and nuclear molding, features suggestive of small cell carcinoma. Cell block immunohistochemistry confirmed small cell carcinoma (CD56+, Syn+, TTF-1+). Molecular testing demonstrated persistence of the original EGFR exon 19 deletion mutation, and single-cell sequencing supported clonal origin.
CONCLUSION: Integrated cytological and molecular analysis of pleural fluid can provide compelling evidence supporting small cell transformation in EGFR-mutant lung adenocarcinoma. The shared EGFR mutation between the primary and transformed tumors is consistent with clonal evolution. This minimally invasive approach offers a practical alternative to tissue re-biopsy for monitoring acquired resistance to EGFR-TKIs.