Although the exact interaction between tobacco, coal and the carcinogenesis of bronchial epithelial cells has not yet been studied, the present case appears to indicate that intensive phosphorylation of ERK kinase caused the unusual spread pattern and eosinophilia of this specific type of LSCC, with dual mutations of KRAS G12A and BRAF V600E. Here, BRAF is linked to Increased total eosinophil count.