CRA9 NAVIGATING COMPLEXITIES: A CHALLENGING CASE OF CD74-ROS1 POSITIVE ADVANCED LUNG ADENOCARCINOMA IN THE SECOND TRIMESTER

Zulkifli.S1
Hospital Pakar Sultanah Fatimah, Muar

Introduction

Lung adenocarcinoma during pregnancy poses a challenge, requiring a balance between maternal care and foetal well-being. In this abstract, we report a case of a pregnant woman in her second trimester diagnosed with advanced lung adenocarcinoma with CD74-ROS1 positive mutation.

Case Report

A 37-year-old woman presented in October 2023 with chronic cough and shortness of breath at 10 weeks of pregnancy, along with weight loss and loss of appetite. A chest X-ray revealed left-sided pleural effusion. Diagnostic tapping showed an exudative profile, initially treated as pneumonia with antibiotics. A follow-up chest X-ray showed persistent pleural effusion.

Pleural fluid cytology revealed malignant cells, suggestive of adenocarcinoma, with BerEp4, CK7, and TTF1 positivity. To minimise foetal radiation, a CT Thorax and USG Abdomen were performed. She was diagnosed with advanced lung adenocarcinoma (T4, N3, M1a) with a negative EGFR TK domain sensitising mutation. A multidisciplinary team discussed prognosis, treatment options, and the continuation of pregnancy.

The patient chose to continue the pregnancy and started chemotherapy with carboplatin and paclitaxel at 18 weeks gestation. At 23 weeks, she experienced sudden breathlessness and chest pain; a chest X-ray showed massive left pleural effusion, necessitating intubation and chest drainage. She responded well post-extubation. A foetal scan indicated viability. However, at 24 weeks, an antenatal scan showed intrauterine foetal death with signs of scalp edema, pericardial and pleural effusions, and ascites. Subsequent Tissue NGS revealed CD74-ROS1 positivity, and the patient was started on Crizotinib. She is currently doing well with an ECOG score of 0.

Conclusion

This case highlights the complex management of advanced lung adenocarcinoma during pregnancy, emphasising the importance of a multidisciplinary approach, the challenges of balancing maternal and foetal health, and raises the question of whether the earlier introduction of Crizotinib might have reduced the risk of intrauterine foetal death following significant complications.