Journal
JOURNAL OF CLINICAL PATHOLOGY
Volume 70, Issue 9, Pages 798-802Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/jclinpath-2017-204370
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Non-small cell lung carcinoma harbouring epidermal growth factor receptor (EGFR) mutation, usually progress after an initial response to tyrosine-kinase inhibitors (TKI). Liquid biopsy enables with a simple blood draw the accurate detection of EGFR p. T790M mutation, the most common resistance mechanism, avoiding the more invasive tissue re-biopsy. However, in a subset of cases, resistance mechanisms are more complex featuring both genetic and morphological changes. Here we report the case of a 67 years-old woman, affected by an EGFR mutated lung adenocarcinoma and treated by TKI. At disease progression, the patient developed a morphological transition to squamous cell carcinoma in association to the arising of a PIK3CA p. E542K mutant subclone. This case illustrates that, even in the liquid biopsy era, cytology can have still a role by providing an overall assessment of both morphology and genetic TKI resistance mechanisms.
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