The Molecular Signature More Than the Site of Localization Defines the Origin of the Malignancy

• Main Authors: Antonio Matrone, Liborio Torregrossa, Elisa Sensi, Daniele Cappellani, Walter Baronti, Raffaele Ciampi, Eleonora Molinaro, Clara Ugolini, Aleksandr Aghababyan, Luigi De Napoli, Francesco Latrofa, Gabriele Materazzi, Fulvio Basolo, Paolo Vitti, Rossella Elisei
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2019-12-01
• Series: Frontiers in Oncology
• Subjects: cancer; thyroid cancer; lung cancer; mutation—genetics; molecular oncology
• Online Access: https://www.frontiersin.org/article/10.3389/fonc.2019.01390/full

The diagnosis of the primary origin of metastases to the thyroid gland is not easy, in particular in case of concomitant lung adenocarcinoma which shares several immunophenotypical features. Although rare, these tumors should be completely characterized in order to set up specific therapies. This is the case of a 64-years-old woman referred to our institution for a very advanced neoplastic disease diagnosed both as poorly differentiated/anaplastic thyroid cancer (PDTC/ATC) for the huge involvement of the neck and concomitant lung adenocarcinoma (LA). Neither the clinical features and the imaging evaluation nor the tumor markers allowed a well-defined diagnosis. Moreover, the histologic features of the thyroid and lung biopsies confirmed the synchronous occurrence of two different tumors. The molecular analysis showed a c.34G>T (p.G12C) mutation in the codon 12 of K-RAS gene, in both tissues. Since, this mutation is highly prevalent in LA and virtually absent in PDTC/ATC the lung origin of the malignancy was assumed, and the patient was addressed to the correct therapeutic strategy.