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66 The 2 components of the surgically resected tu‐ mor were precisely separated by manual microdis‐ section under microscope to avoid contamination of each sample by different components. An epi‐ dermal growth factor receptor (EGFR) exon 19 de‐ letion, but not the T790M mutation, was identified in both components. Thereafter, the patient devel‐ oped several small cavitary metastases (<10 mm in size) in both lungs (FIGURE 1B). She was admin‐ istered EGFR ‐tyrosine kinase inhibitors and cy‐ totoxic chemotherapies (gefitinib for 23 months; 4 cycles of carboplatin, pemetrexed, and bevaci‐ zumab; 15 cycles of pemetrexed and bevacizumab for 15 months; afatinib for 13 months; and 17 cy‐ cles of docetaxel and bevacizumab for 15 months), A 72 ‐year ‐old woman with no history of smok‐ ing presented to our hospital with dizziness for the past 3 weeks. Nine years earlier, she had he‐ moptysis, and a large tumor in the left lung was revealed by chest computed tomography (FIGURE 1A). The patient underwent a lobectomy of the left lower lung and mediastinal lymph node dissection. The resected tumor consisted of the components of adenocarcinoma as well as squamous cell carcinoma, each comprising more than 10% of the tumor. The final pathological di‐ agnosis was lung adenosquamous cell carcino‐ ma, and the tumor was staged as pT3bN1M1a according to the TNM classification. CLINICAL IMAGE

Cerebellar metastasis with the cavity of both components of lung adenosquamous cell carcinoma