Response to first-line erlotinib in a false EGFR mutation-negative patient with non-small-cell lung cancer: Make no assumptions

Case ReportA 42-year-old Asian man presented with progressive cough, expectoration and chest pain admitted to our department on January 28, 2013.His past medical history was notable for a 40 pack-year history of smoking.The carcinoembryonic antigen (CEA) serum level tested on January 31, 2013, was 276.37ug/l (the normal value of limitation is 5.0ug/l).Chest Computed tomography (CT) on February 5, 2013, showed a large number of miliary tubercles scattered in two lungs, which like metastatic lesions; one well-defi ned lesion lied in the posterior segment of the right upper lobe, whose edge is not smooth and diameter is about 2cm, among which pleural indentation sign and spicule sign should be found; a few of enlarged lymph nodes located in the mediastinum, among which the maximum diameter is 2.3cm.A CT-guided percutaneous needle biopsy was performed on February 18, 2013, and the pathological fi ndings showed adenocarcinoma.Imaging by PET-CT on February 28, 2013, showed intense fl uorodeoxyglucose activity in the right upper-lobe nodule, SUV max was7.3,diameter was about 2.92cmx2.72cm(Figure 1).Extensive fl uorodeoxyglucose activity was also evident within the following lymph nodes: double hilars, mediastinal, right neck, right subclavian, right upper trachea, retrocaval, and carinal.Of which the SUV max was 12.17 and the maximum diameter is 3.36cmx2.92cm.At the same time, it showed miliary nodules in double lung seem to be metastatic lesions with great possibility.