Diagnosis and treatment of primary pulmonary enteric adenocarcinoma: Report of Six cases

BACKGROUND

Primary pulmonary enteric adenocarcinoma (PEAC) is a very rare subtype of invasive adenocarcinoma, and there have been no large studies on PEAC to date. Therefore, it is necessary to obtain much more information about the clinical and pathological features, diagnosis, differential diagnosis, and treatment of PEAC.

CASE SUMMARY

All clinical data of six patients with confirmed PEAC from 2013 to 2018 were collected, and data on diagnosis, differential diagnosis, and treatment of PEAC are discussed combined with all the associated literature. The mean age of six patients was 64.0 ± 5.6 (59-73) years old. Their clinical manifestations were heterogeneous, and during their disease course, there were no gastrointestinal symptoms. There was no evidence from colonoscopy or imaging studies to suggest digestive tract tumors or new metastases. The most commonly mutated gene was KRAS (50.0%), and the pathological features of the six cases were similar to those of colorectal cancer. CDX2 (83.3%) and CK7 (66.7%) had the highest positive rates upon immunohistochemical examination. In the associated literature, 252 cases were identified, and the most commonly mutated gene was KRAS (42.9%). Additionally, CDX2 (68.3%) and CK7 (85.8%) had the highest positive rates. Patients mainly received surgery, chemotherapy, and radiotherapy, immunotherapy was not included.

CONCLUSION

Positive results for CDX2 and CK7 play an important role in the diagnosis and differential diagnosis of PEAC, and immunotherapy or targeted therapy focused on KRAS needs to be further studied for the treatment of PEAC.

Natural ageing responses of duplex structured Mg-Li based alloys

Natural ageing responses of duplex structured Mg-6%Li and Mg-6%Li-6%Zn-1.2%Y alloys have been investigated. Microstructural analyses revealed that the precipitation and coarsening process of α-Mg particles could occur in β-Li phases of both two alloys during ageing process. Since a certain amount of Mg atoms in β-Li phases were consumed for the precipitation of abundant tiny MgLiZn particles, the size of α-Mg precipitates in Mg-6%Li-6%Zn-1.2%Y alloy was relatively smaller than that in Mg-6%Li alloy. Micro hardness measurements demonstrated that with the ageing time increasing, the α-Mg phases in Mg-6%Li alloy could have a constant hardness value of 41 HV, but the contained β-Li phases exhibited a slight age-softening response. Compared with the Mg-6%Li alloy, the age-softening response of β-Li phases in Mg-6%Li-6%Zn-1.2%Y alloy was much more profound. Meanwhile, a normal age-hardening response of α-Mg phases was maintained. Tensile results indicated that obvious ageing-softening phenomenon in terms of macro tensile strength occurred in both two alloys. Failure analysis demonstrated that for the Mg-6%Li alloy, cracks were preferentially initiated at α-Mg/β-Li interfaces. For the Mg-6%Li-6%Zn-1.2%Y alloy, cracks occurred at both α-Mg/β-Li interfaces and slip bands in α-Mg and β-Li phases.