Despite tobacco smoking being the strongest riskfactor for developing lung cancer, it is estimated that approximately 25% ofall lung cancers are not associated with tobacco use (Sun et all). Smoking hasa stronger correlation with small cell lung cancer and squamous cell carcinoma,however, adenocarcinoma seems to be the most common form of lung cancer innon-smoker and lung cancer in the young. Adenocarcinoma is a histological subsetof non-small lung cancer that is comprised ofepithelial tissue that has a glandular origin or glandular characteristics.
Recent research has been able to further define specific ‘driver’mutations that reoccur in NSCLC subtypes. These driver mutations occur incancer cells and are made up of genes encoding for proteins involved in survivaland cell growth. EGFR, HER2, ALK, RET, and ROS1 mutations are found morecommonly in adenocarcinoma of non-smokers.
On a positive note, new therapeutic agentsare currently available or are being developed to specifically target thesemutations and have shown to slow down the progression of these cancers.Another disease todiscuss in this case report is syphilis. Syphilis is caused Treponema pallidum whichis a bacteria that is transmitted through sexual contact or as a congenital infectionfrom mother to baby. Thereare several stages of syphilis. In the primary stage, the patient presents witha chancre. The secondary stage involves a variable rash and systemic symptoms.
Thereis also a latent stage where the patient is classically asymptomatic. The lateor tertiary stage occurs within 15 to 30 years of initial infection and is associatedwith significant organ damage such as gummatous, cardiovascular,ophthalmologic, neurologic, or osseous aberrations. An important complicationof tertiary syphilis related to this case is aortitis.
Aortitis is a consequenceof vasculitis of the vasa vasorum causing weakening of the wall of the aortic rootthat can lead to aortic rupture and possibly death.