Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 10, 2017; 8(4): 360-365
Published online Aug 10, 2017. doi: 10.5306/wjco.v8.i4.360
BRAF V600Q-mutated lung adenocarcinoma with duodenal metastasis and extreme leukocytosis
Ayman Qasrawi, Addison Tolentino, Mouhanna Abu Ghanimeh, Omar Abughanimeh, Sakher Albadarin
Ayman Qasrawi, Mouhanna Abu Ghanimeh, Omar Abughanimeh, Department of Internal Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64108, United States
Addison Tolentino, Saint Luke’s Cancer Specialists, Saint Luke’s Hospital of Kansas City, Kansas City, MO 64111, United States
Sakher Albadarin, Division of Gastroenterology, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64108, United States
Author contributions: Qasrawi A wrote the manuscript; Tolentino A reviewed, modified and edited the manuscript; Abu Ghanimeh M and Abughanimeh O contributed to the literature review; Albadarin S performed the endoscopy, provided the images and wrote up the endoscopic findings.
Institutional review board statement: This case report was exempt from the Internal Review Board standards of University of Missouri - Kansas City School of Medicine and Saint Luke’s Hospital of Kansas City.
Informed consent statement: The patient provided verbal informed consent for the publication of the contents of the manuscript before her death, authorizing use and disclosure of her protected health information. Personal details have been anonymized to protect her identity.
Conflict-of-interest statement: The authors have no competing interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ayman Qasrawi, MD, Department of Internal Medicine, University of Missouri - Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States. qasrawia@umkc.edu
Telephone: +1-816-5727576 Fax: +1-816-9325793
Received: April 8, 2017
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
Abstract

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.

Keywords: BRAF, Lung adenocarcinoma, Duodenum, Metastasis, Gastrointestinal bleeding, Endoscopy, Leukocytosis

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.