17150 Non-small cell carcinoma of lung frequently associated with cigarette smoking is extremely rare in children. We, here, describe a 13-year-old female diagnosed with stage IV pulmonary adenocarcinoma. She had never started smoking. Yet, she had environmental tobacco smoking exposure in the household as her father had been a long-time heavy smoker. The patient presented with 6-month history of chronic recurring cough. A CT of chest showed a mass obstructing the left upper lung bronchus with a collapse of the lung in the left upper segment. A bronchoscopic biopsy revealed a poorly differentiated adenocarcinoma. There were bilateral pleural and pericardial effusions along with multiple nodular lesions in the brain, liver and bones suggesting of wide dissemination of the lung cancer. In her past, there was no history of radiation exposure or immune deficiency. She had never had any other childhood cancer treated previously. Interestingly, there was no evidence of EGFR gene mutation in the genomic DNA analysis of the tumor specimen. In the hospital, she was treated with palliative chemotherapy initially starting with gefitinib and later with regimen of navelbine, gemcitabine and cisplatin combination with no response. A palliative radiation therapy to mediastinum was added mainly to relieve her airway obstruction. Currently, after 6 months from initial diagnosis, she remains clinically stable and ambulatory without tumor progression on docetaxel monthly chemotherapy cycle. Our report here suggests that a primary pulmonary adnenocarcinoma without previous radiation exposure to chest in a child who never had smoking may occur. It might be that environmental tobacco smoking exposure may have had a deleterious impact. No significant financial relationships to disclose.
EGFR gene-mutation status correlated with therapeutic decision making in lung adenocarcinoma
