Published online Aug 10, 2017. doi: 10.5306/wjco.v8.i4.360
Peer-review started: April 17, 2017
First decision: May 22, 2017
Revised: June 11, 2017
Accepted: June 30, 2017
Article in press: July 3, 2017
Published online: August 10, 2017
Driver mutations in patients with non-small cell lung cancer (NSCLC) can lead to distinct behaviors and patterns of metastasis. Mutations in the proto-oncogene B-raf (BRAF) occur in approximately 3% of NSCLC cases. In the literature, reports of patients with lung adenocarcinomas metastasizing to the duodenum are rare, and most of the only 21 cases reported were from before the advent of next-generation sequencing. We present here a case involving a 57-year-old female who had a lytic lesion in her lesser trochanter. Biopsy showed metastatic adenocarcinoma of lung origin. Chest X-ray showed a large left upper lobe mass. Next-generation sequencing analysis confirmed the presence of BRAF V600Q mutation. The patient presented with persistent anemia and melena. Esophagogastroduodenoscopy confirmed the presence of duodenal metastasis. She also had suspected paraneoplastic leukemoid reaction. To our knowledge, this is only the second well-documented case of gastrointestinal metastasis from BRAF-mutated lung cancer.
Core tip: We report a rare and interesting case of BRAF-mutated lung adenocarcinoma with metastases to the bone and duodenum, and extreme leukocytosis. We found next-generation sequencing to be helpful in prognostication and determination of some of the unique clinical behaviors of lung adenocarcinoma. This is only the second case of BRAF-mutated lung adenocarcinoma with well documented metastases to the gastrointestinal tract. The addition of this case to the literature should prompt interest in studying the propensity of BRAF-mutated malignancies to metastasize to the gastrointestinal tract.