RESUMO
ROS1-rearrangement occurs in 1-2% of non-small cell lung cancer (NSCLC). This mutation is predominantly seen in relatively young, non-smoker, female with adenocarcinoma. Association of pulmonary embolism with ROS1-rearranged NSCLC has been suggested. We report a case of a 22-year-old woman with ROS1-positive NSCLC and pulmonary embolism. This case possibly represents the youngest patient in the literature.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/genética , Neoplasias Pulmonares/patologia , Proteínas Tirosina Quinases/genética , Proteínas Proto-Oncogênicas/genética , Embolia Pulmonar/diagnóstico , Adenocarcinoma de Pulmão/classificação , Adenocarcinoma de Pulmão/diagnóstico , Anticoagulantes/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Feminino , Rearranjo Gênico/genética , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Terapia de Alvo Molecular/métodos , Mutação , Estadiamento de Neoplasias/métodos , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/metabolismo , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Toracentese/instrumentação , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos , Adulto JovemRESUMO
The term 'refractory asthma' includes patients with severe asthma, steroid-dependent and/or resistant asthma, difficult-to-treat asthma and irreversible asthma. In patients with to difficult to treat asthma, exclusion of other causes of persistent wheeze like vocal cord dysfunction, upper airway obstruction and allergic bronchopulmonary aspergillosis is important. Besides, the presence of anatomical abnormalities that could affect effective medication delivery could also result in sub-optimal treatment response. These factors reiterate the need for a rigorous and systematic approach to rule out alternative co-existent diseases or abnormalities in a patient with difficult-to-treat asthma. We hereby report a case of an asthmatic patient with refractory bronchospasm despite optimal treatment, wherein work-up for an additional pathophysiological process aided in successful management of his symptoms.