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array:23 [ "pii" => "S0025775323001495" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.03.010" "estado" => "S300" "fechaPublicacion" => "2023-08-11" "aid" => "6225" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2023;161:137" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0025775323001720" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.03.024" "estado" => "S300" "fechaPublicacion" => "2023-08-11" "aid" => "6240" "copyright" => "Elsevier España, S.L.U." 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He had an ECOG performance status of 2 and on physical examination, nodules were palpable on his neck and arms. Computed tomography of the whole body revealed pulmonary nodules in both lungs and multiple lytic lesions (sacrum, vertebral bodies). Whole-body positron-emission tomography revealed hypermetabolic areas in most body structures, including muscle, bones and subcutaneous tissue. Biopsy of a muscle nodule revealed poorly differentiated adenocarcinoma metastasis of probable pulmonary origin (cytokeratin 20 negative, cytokeratin 7 positive, TTF1 negative, napsin A negative, p63 negative). Next generation sequencing was performed identifying an alteration in KRAS, c.34G>A, p.G12S with a VAF of 32.1% out of 4058 readings classified as pathogenic and a PDL1 expression in neoplastic cells in a range of 70%. 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