{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:23:44Z","timestamp":1788276224300,"version":"build-2803163510"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diagnostic Cytopathology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Histological transformation of lung adenocarcinoma to small cell carcinoma is a rare but critical mechanism of acquired resistance to EGFR\u2010TKIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case<\/jats:title>\n                    <jats:p>A 65\u2010year\u2010old woman with EGFR\u2010mutant lung adenocarcinoma developed new\u2010onset massive pleural effusion after an initial partial response to icotinib. Pleural fluid cytology revealed tumor cells with high nuclear\u2010to\u2010cytoplasmic ratio, finely granular chromatin, and nuclear molding, features suggestive of small cell carcinoma. Cell block immunohistochemistry confirmed small cell carcinoma (CD56+, Syn+, TTF\u20101+). Molecular testing demonstrated persistence of the original EGFR exon 19 deletion mutation, and single\u2010cell sequencing supported clonal origin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integrated cytological and molecular analysis of pleural fluid can provide compelling evidence supporting small cell transformation in EGFR\u2010mutant lung adenocarcinoma. The shared EGFR mutation between the primary and transformed tumors is consistent with clonal evolution. This minimally invasive approach offers a practical alternative to tissue re\u2010biopsy for monitoring acquired resistance to EGFR\u2010TKIs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dc.70177","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:12:12Z","timestamp":1783426332000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pleural Fluid Cytology Detects Small Cell Carcinoma Transformation in\n                    <scp>EGFR<\/scp>\n                    \u2010Mutant Lung Adenocarcinoma: A Case Report"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3432-4827","authenticated-orcid":false,"given":"Huijun","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine Suining Central Hospital  Suining Sichuan Province 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