{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:47:42Z","timestamp":1792054062831,"version":"4.4.0"},"reference-count":16,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP300025K20595"],"award-info":[{"award-number":["JP300025K20595"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Histological transformation to sarcomatoid carcinoma is an extremely rare mechanism of resistance to tyrosine kinase inhibitors. Among adenocarcinoma subtypes, transformation of pulmonary invasive mucinous carcinoma (IMA) into other histological types has not previously been reported. We present the case of a 74\u2010year\u2010old man referred to our hospital with abnormal lung shadows. Chest computed tomography (CT) revealed extensive consolidation predominantly in the right lower lobe. Transbronchial biopsy specimens confirmed IMA, which was negative for thyroid transcription factor\u20101, and a\n                    <jats:italic>BRAF<\/jats:italic>\n                    D594G mutation was detected. As surgical resection was not feasible, first\u2010line treatment with ipilimumab plus nivolumab combined with chemotherapy was initiated, resulting in a partial response. After 19\u2009cycles of maintenance therapy, treatment was discontinued because of suspected interstitial lung disease (ILD). Thirteen months later, the patient developed radiographic worsening of ILD, for which oral prednisolone was initiated. Two months later, CT imaging revealed rapid disease progression, with enlargement of right supraclavicular, mediastinal, and abdominal lymph nodes. Re\u2010biopsy of a mediastinal lymph node demonstrated sarcomatoid carcinoma positive for vimentin and pan\u2010cytokeratin AE1\/AE3. Genomic analyses again identified the\n                    <jats:italic>BRAF<\/jats:italic>\n                    D594G mutation, confirming sarcomatous transformation of the original IMA. The patient received two cycles of nab\u2010paclitaxel plus carboplatin without response and subsequently died. These findings emphasize that clinicians should recognize that IMA may undergo sarcomatous transformation.\n                  <\/jats:p>","DOI":"10.1111\/1759-7714.70327","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T01:48:35Z","timestamp":1781747315000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sarcomatoid Transformation of Pulmonary Mucinous Adenocarcinoma as a Mechanism of Immunotherapy Resistance"],"prefix":"10.1111","volume":"17","author":[{"given":"Kensuke","family":"Yanai","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9512-4839","authenticated-orcid":false,"given":"Tomohiro","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konomi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Hirose","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Masuda","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Kushiro","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naohiro","family":"Yanagimura","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Kondo","sequence":"additional","affiliation":[{"name":"Division of Molecular and Diagnostic Pathology Niigata University Graduate School of Medical and Dental Sciences  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Nozaki","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Saida","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyuki","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0041-6981","authenticated-orcid":false,"given":"Satoshi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Umezu","sequence":"additional","affiliation":[{"name":"Division of Pathology Niigata University Medical and Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Department of Medicine Jichi Medical University  Shimotsuke Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiaki","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases Niigata University Medical &amp; Dental Hospital  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13184641"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1515\/jtim-2024-0019"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-12-2246"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2021.11.003"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0176525"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/17588359241236450"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2019.08.029"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.54.4987"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.21037\/tlcr.2016.04.07"},{"key":"e_1_2_11_11_1","first-page":"5641","article-title":"Tenascin C in Pancreatic Cancer\u2010Associated Fibroblasts Enhances Epithelial Mesenchymal Transition and Is Associated With Resistance to Immune Checkpoint Inhibitor","volume":"13","author":"Furuhashi S.","year":"2023","journal-title":"American Journal of Cancer Research"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbadis.2017.12.021"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.6.1868"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature23291"},{"key":"e_1_2_11_15_1","first-page":"45","article-title":"Therapy for Stage IV Non\u2010Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2025.1","volume":"43","author":"Owen D. 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