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中华介入放射学电子杂志 ›› 2025, Vol. 13 ›› Issue (04) : 383 -387. doi: 10.3877/cma.j.issn.2095-5782.2025.04.018

所属专题: 经典病例

病例报告

基于二次活检结果指导治疗转化型小细胞肺癌一例并文献复习
吴盛楠, 穆宁, 刘梅, 徐悦, 吕欢, 王欣怡, 马春华()   
  1. 300121 天津,天津市人民医院肿瘤诊疗中心肿瘤5科
  • 收稿日期:2024-12-03 出版日期:2025-11-25
  • 通信作者: 马春华
  • 基金资助:
    天津市医学重点学科(专科)建设项目(TJYXZDXK-053B)

Treatment of Transformed Small Cell Lung Cancer Guided by Rebiopsy: A Case Report

Shengnan Wu, Ning Mu, Mei Liu, Yue Xu, Huan Lv, Xinyi Wang, Chunhua Ma()   

  1. Tianjin People's Hospital, Tianjin 300121, China
  • Received:2024-12-03 Published:2025-11-25
  • Corresponding author: Chunhua Ma
引用本文:

吴盛楠, 穆宁, 刘梅, 徐悦, 吕欢, 王欣怡, 马春华. 基于二次活检结果指导治疗转化型小细胞肺癌一例并文献复习[J/OL]. 中华介入放射学电子杂志, 2025, 13(04): 383-387.

Shengnan Wu, Ning Mu, Mei Liu, Yue Xu, Huan Lv, Xinyi Wang, Chunhua Ma. Treatment of Transformed Small Cell Lung Cancer Guided by Rebiopsy: A Case Report[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(04): 383-387.

2023年6月29日天津市人民医院收治1例晚期肺腺癌女性患者,患者系EGFR 19外显子缺失突变多线治疗后,复查血液基因检测仍提示EGFR突变,但靶向治疗无效。患者再次行肺穿刺活检,病理明确为小细胞肺癌,予支气管动脉灌注化疗联合达可替尼分子靶向治疗、安罗替尼抗血管生成治疗,最佳疗效达部分缓解,无进展生存为4个月。治疗过程中,及时的二次活检提示病理转化,动脉灌注化疗联合靶向治疗成功控制病情,希望此案例能对转化型小细胞肺癌的治疗提供参考。

On June 29, 2023, Tianjin People's Hospital admitted a female patient with advanced lung adenocarcinoma. The patient had undergone multiple lines of treatment,re-examination of the blood genetic test still indicated EGFR mutation, but targeted therapy was ineffective. The patient underwent another lung biopsy, which confirmed the pathology as small cell lung cancer. She received bronchial arterial infusion chemotherapy combined with molecular targeted therapy (Dacomitinib) and anti-angiogenesis therapy (Anlotinib), achieving partial response (PR) with a progression-free survival (PFS) of 4 months. During the treatment process, timely secondary biopsy indicated pathological transformation, and the combination of arterial infusion chemotherapy and targeted therapy successfully controlled the disease. This case may provide valuable insights for the treatment of transformed small cell lung cancer.

图1 治疗前CT影像 2023年6月29日,入院时胸部CT:右肺门旁可见不规则肿物影,最大横截面积约为8.5 cm×7.1 cm,其内可见类圆形低密度影及不规则致密影。
图2 介入术中DSA影像 2A:右侧支气管动脉及肋间动脉(黑色箭头),右侧支气管动脉及肿瘤血管染色(红色箭头);2B:微导管超选择右侧支气管动脉(黑色箭头)
图3 治疗后CT影像 3A:2023年8月14日,治疗后胸部CT:右肺上叶肿物较前(2023-06-29)缩小,最大横截面积约为5.6 cm×2.7 cm;3B:2023年9月25日,继续治疗后胸部CT:右肺上叶肿物较前(2023-08-14)缩小,最大横截面积约为3.0 cm×1.8 cm;3C:2023年11月8日,口服靶向治疗后胸部CT:右肺上叶肿物伴右肺阻塞性肺不张,较前(2023-9-25)增大;3D:2023年12月25日,重启介入治疗后胸部CT:右肺上叶不规则软组织密度影,伴右肺上叶阻塞性不张;纵隔、右肺门、双侧锁骨上窝、右侧心膈角及膈肌脚多发淋巴结转移;3E:2024年1月11日,免疫治疗后胸部CT:右肺上叶不规则软组织密度影,伴阻塞性肺不张,较前(2023-12-25)无著变;纵隔、右肺门、双侧锁骨上窝、右侧心膈角及膈肌脚多发淋巴结转移,累及邻近上腔静脉及左头臂静脉,较前增大。
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