CASE REPORT   

Minerva Pneumologica 2017 December;56(4):266-70

DOI: 10.23736/S0026-4954.17.01800-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

A case of lung adenocarcinoma with increased serum neuron-specific enolase

Junzo SHIMIZU ¹ ✉, Saki HAYASHI ¹, Makio MORIYA ¹, Tadashi KAMESUI ¹, Yoshihiko ARANO ², Koichiro KOBAYASHI ³, Akitaka NONOMURA ⁴

¹ Department of Chest Surgery, Hokuriku Central Hospital, Oyabe, Japan; ² Department of Surgery, KKR Hokuriku Hospital, Kanazawa, Japan; ³ Department of Chest Surgery, Toyama Red Cross Hospital, Toyama, Japan; ⁴ Department of Pathology, Hokuriku Central Hospital, Oyabe, Japan

A 57-year-old man presented with an abnormal shadow in the left middle lung field on chest radiography. Chest computed tomography (CT) showed an irregular mass (1.6 cm of maximum diameter) in the peripheral S3 segment of the left lung. The preoperative serum neuron-specific enolase (NSE) level was elevated (34.1 ng/mL; normal range, 0-16.3 ng/mL). Primary lung cancer was suspected and left upper lobectomy was performed. Papillary adenocarcinoma of the lung (pT1bN0M0, pStage IA2) was diagnosed histopathologically. A subset of adenocarcinoma cells stained positive for NSE, while all tumor cells were negative for neuroendocrine markers (chromogranin A, synaptophysin, and CD56). Postoperative serum NSE levels were within the reference range, and imaging showed no evidence of cancer metastases or recurrence. However, 49 months postoperatively, serum NSE increased to 98.8 ng/mL, and metastases to the left lower lobe and para-aortic lymph nodes were observed on chest CT. The lesions responded well to radiotherapy and chemotherapy; serum NSE decreased and remained within the reference range for 2 years. However, 66 months postoperatively, metastases to the contralateral lung occurred, and after 75 months (26 months after radiotherapy), the patient died of metastases to the contralateral lung and the cervical vertebrae. The final serum NSE level was elevated (35.1 ng/mL). In this patient, serum NSE levels were indicative of the clinical course. This finding suggests that serum NSE may be indicative of disease status in certain cases of non-small cell lung cancer, and can be used to evaluate cancer recurrence and treatment response.

KEY WORDS: Non-small-cell lung carcinoma - Phosphopyruvate hydratase - Survival rate - Prognosis