A mimic of lung adenocarcinoma: a case report of histological conversion of metastatic thyroid papillary carcinoma

In a patient with a history of cancer, distinguishing a metastasis of the prior tumour from a new primary tumour relies on the comparison of morphological features between the tumour of concern and the prior tumour, often with the aid of immunohistochemistry. This approach is the basis of pathological diagnosis, but recent advances in precision cancer medicine and cancer treatments change the situation. We here present a case report of lung cancer, mimicking primary lung adenocarcinoma, with minute foci of metastatic thyroid papillary carcinoma, in a 34-year-old man with a history of papillary thyroid carcinoma. Through the analysis of thyroid tumor and lung tumor at the age of 4 and 34 years in this patient, identical NCOA4-RET translation suggested histological conversion, which was induced probably due to high selective pressure by the treatment. As histological transformation of non-small cell lung cancer is well documented as a form of recurrence after EGFR-tyrosine kinase inhibitor treatment, the lineage conversion in association with effective treatments may be a diagnostic pitfall in the era of precision cancer medicine.

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