NUT Carcinoma of the Lung：A Case report and Literature Analysis

Abstract

NUT carcinoma is a rare, highly aggressive cancer that feature as the rearrangement of the nuclear protein in the testis (NUT) gene on chromosome 15q14, and its pathogenesis and treatment is not yet clear. In this case, we report a 40-year-old male patient who was diagnosed with primary pulmonary NUT carcinoma in The Second Affiliated Hospital of Zhengzhou University. A tumor was found at the right hilus pulmonis when his physical examination with chest pain for half a month. Histopathology confirmed by fluorescence in situ hybridization technique for the NUT carcinoma. After chemotherapy, radiotherapy, immunotherapy, and targeted therapy were given, the patient died. The overall survival time was 4.7 months. Combined with the existing literature, we retrospective report the clinical and pathological characteristics and treatment strategies of the rare lung NUT carcinoma.

Keywords: case report; literature analysis; lung; midline carcinoma; nuclear protein in testis.

Figure 1

(A) CT of the patient’s chest (July 10, 2018) shows: Massive soft tissue-like density shadows can be seen near the hilar of the right upper lung, the size is about 11.4cm* 10.7cm, the enhanced scan is uneven and moderately enhanced; (B) The patient’s chest CT (September 11, 2018) after VAI regimen chemotherapy showed that the size of the right lung mass was about 8.9*8.1 cm, which was smaller than before, but the mediastinal lymph nodes were enlarged; (C) (September 30,2018) The size of the right lung mass is about 12.1cm*10.5 cm, which is larger than before. (D) (October 11, 2018) The soft tissue-like density shadow of the right upper lobe of the right lung mass, the right hilum is compressed, the main trachea of the right lower lung is compressed and narrowed, and the righthilar and mediastinum have multiple enlarged lymph nodes.

Figure 2

(A) Tumor small-medium size, fine nuclear staining, no nucleoli (HE, 10X); (B) Tumor small-medium size, fine nuclear staining, no nucleoli (HE, 40X); (C) 1.P40 positive(Immunohistochemical staining); 2. TTF-1 positive (Immunohistochemical staining); 3. SyN positive (Immunohistochemical staining); NUT positive (Immunohistochemical staining); (D) Fluorescence in situ hybridization (FISH) display: 45% of tumor cells show red and green separation signals (DAPI color development, 1000X).