EGFR-mutant lung adenocarcinoma featuring massive bronchorrhea, a dominant pulmonary nodule, and migratory ground-glass opacities: a case report and literature review

Lung cancer exhibits profound clinical, radiological, and biological heterogeneity, which poses significant challenges for early recognition and timely diagnosis in select atypical cases. Among rare manifestations, massive bronchorrhea caused by EGFR-mutated lung adenocarcinoma with radiological findings of a dominant pulmonary nodule and migratory ground-glass opacities (GGOs) remains extremely uncommon. A 67-year-old male patient presented with massive bronchorrhea and progressive dyspnea. Serial chest computed tomography (CT) scans revealed bilateral migratory GGOs and a small nodular lesion in the basal segment of the right lower lobe. Empiric antibiotic therapy and subsequent systemic corticosteroid treatment failed to alleviate his respiratory symptoms. Ultimately, markedly elevated sputum carcinoembryonic antigen (CEA) levels, combined with pathological results from transbronchial biopsy of the right lung nodule, confirmed a diagnosis of EGFR-mutated lung adenocarcinoma. Treatment with osimertinib achieved rapid resolution of bronchorrhea, accompanied by complete regression of the pulmonary nodule and GGOs during clinical follow-up. Clinicians should maintain a high index of suspicion for lung adenocarcinoma in patients with persistent unexplained bronchorrhea. For patients harboring EGFR-sensitive mutations, EGFR tyrosine kinase inhibitors (TKIs) remain the first-line treatment, yielding favorable therapeutic effects on bronchorrhea control and improving survival outcomes.