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Case Report Open Access

Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report

  • Authors:
    • Qingsong Wang
    • He Zheng
    • Mingpu Wang
    • Xiaoyu Wei
    • Yuzhen Ma
    • Zhengqiang Wan
  • View Affiliations / Copyright

    Affiliations: Department of Thoracic Surgery, The First People's Hospital of Suining, Suining, Sichuan 264000, P.R. China, Department of Oral and Maxillofacial Surgery, The First People's Hospital of Suining, Suining, Sichuan 264000, P.R. China
    Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 417
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    Published online on: July 1, 2025
       https://doi.org/10.3892/ol.2025.15163
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Abstract

Venous thromboembolism (VTE) is a well‑documented complication in lung cancer; however, the culmination of multi‑site thrombosis in splenic infarction remains extremely rare. The present case report highlighted the complex interplay between oncogenic drivers and coagulation abnormalities in advanced non‑small cell lung cancer (NSCLC). A 37‑year‑old man with stage IVA (T3N2M1a) EGFR‑L858R‑mutated lung adenocarcinoma presented with acute left upper quadrant pain. Despite prophylactic anticoagulation with rivaroxaban (10 mg twice daily), imaging indicated progressive thrombosis involving the splenic artery, superior vena cava, and deep veins of the neck and lower extremities. Contrast‑enhanced abdominal CT confirmed splenic infarction without secondary abscess formation. The patient underwent intensified anticoagulation with enoxaparin (8,000 IU twice daily) and anti‑infective prophylaxis, which achieved spontaneous splenic infarct resolution on follow‑up imaging (December 2024 to May 2025). The present case underscored three critical clinical insights: i) The paradoxical thrombotic risk profile associated with EGFR‑mutated NSCLC during disease progression; ii) the limitations of current VTE risk assessment tools in advanced malignancies; and iii) the necessity for dynamic anticoagulation strategies in cancer‑associated thrombosis. Clinicians are advised to maintain heightened vigilance for thrombotic complications even in genetically defined NSCLC subsets (such as EGFR‑L858R mutant lung adenocarcinoma) receiving targeted therapies in the future.
View Figures

Figure 1

Chest CT revealing a lung mass and
pericardial effusion, which was confirmed by H&E staining for
lung adenocarcinoma and pericardial metastases. (A)
Contrast-enhanced chest CT identified a pulmonary mass in the left
upper lobe, indicated by the red arrow, which exhibited
characteristic neoplastic morphology. (B) Analysis via H&E
staining of the pleural effusion confirmed metastatic lung
adenocarcinoma. Tumor cells are indicated by the black arrow
(H&E staining; scale bar, 50 µm). (C) Chest CT demonstrated
pericardial effusion. The red arrow indicates thrombosis of the
splenic artery. (D) H&E staining of the pericardial effusion
also revealed lung adenocarcinoma cells. Tumor cells are indicated
by the black arrow (H&E staining; scale bar, 50 µm).

Figure 2

Genetic test results and D-dimer
trend changes. (A) Amplification refractory mutation system-PCR
analysis confirmed a heterozygous activating mutation at exon 21 of
the EGFR gene (c.2573T>G, p.Leu858Arg). The purple horizontal
line represents wild-type; the blue horizontal line represents
mutant-type. (B) Following admission, the D-dimer levels of the
patient exhibited a decreasing trend. Rn, normalized reporter.

Figure 3

Ultrasound findings indicating
multiple thrombi formation in multiple locations and
contrast-enhanced abdominal CT revealing splenic infarction. A
colored scale is used to indicate the direction and relative
velocity of the blood flow signal, with red indicating blood flow
towards the ultrasound probe and blue indicating blood flow away
from the ultrasound probe. (A) Color Doppler ultrasound indicated
thrombosis in the right internal jugular vein. The red arrow
indicates a thrombosis. (B) Color Doppler ultrasound demonstrated
thrombosis in the left popliteal vein. The red arrow indicates a
thrombosis. (C) Color Doppler ultrasound indicated thrombosis in
the left peroneal vein. The red arrow indicates a thrombosis. (D)
Contrast-enhanced abdominal CT demonstrated splenic artery
thrombosis and the red arrow indicates the thrombus. (E)
Contrast-enhanced CT demonstrated wedge-shaped hypodensity in the
splenic parenchyma, indicated by the red arrow, consistent with
ischemic infarction. No evidence of liquefactive necrosis or
abscess formation was observed. (F) Following a standard
anticoagulation regimen (8,000 IU subcutaneously every 12 h), at 1
month post-treatment, contrast-enhanced CT revealed a slight
reduction in the extent of the splenic infarction. The red arrow
indicates the infarcted spleen.
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Copy and paste a formatted citation
Spandidos Publications style
Wang Q, Zheng H, Wang M, Wei X, Ma Y and Wan Z: Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report. Oncol Lett 30: 417, 2025.
APA
Wang, Q., Zheng, H., Wang, M., Wei, X., Ma, Y., & Wan, Z. (2025). Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report. Oncology Letters, 30, 417. https://doi.org/10.3892/ol.2025.15163
MLA
Wang, Q., Zheng, H., Wang, M., Wei, X., Ma, Y., Wan, Z."Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report". Oncology Letters 30.3 (2025): 417.
Chicago
Wang, Q., Zheng, H., Wang, M., Wei, X., Ma, Y., Wan, Z."Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report". Oncology Letters 30, no. 3 (2025): 417. https://doi.org/10.3892/ol.2025.15163
Copy and paste a formatted citation
x
Spandidos Publications style
Wang Q, Zheng H, Wang M, Wei X, Ma Y and Wan Z: Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report. Oncol Lett 30: 417, 2025.
APA
Wang, Q., Zheng, H., Wang, M., Wei, X., Ma, Y., & Wan, Z. (2025). Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report. Oncology Letters, 30, 417. https://doi.org/10.3892/ol.2025.15163
MLA
Wang, Q., Zheng, H., Wang, M., Wei, X., Ma, Y., Wan, Z."Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report". Oncology Letters 30.3 (2025): 417.
Chicago
Wang, Q., Zheng, H., Wang, M., Wei, X., Ma, Y., Wan, Z."Splenic infarction secondary to multi‑site thrombosis in lung adenocarcinoma with EGFR‑L858R mutation: A case report". Oncology Letters 30, no. 3 (2025): 417. https://doi.org/10.3892/ol.2025.15163
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