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case_images: CT shows (A) the puncture position. (B-D) new lung cavities and metastases before treatment with anlotinib. (E-H) stabilization of lung lesions after anlotinib treatment. The red arrows in the figure indicate changes in lesions before and after treatment.
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case_images: The patient underwent CT-guided percutaneous lung biopsy for diagnosis confirmation (Figure 1A). CT scan and enhancement showed multiple nodules in the right lung, a nodule in the upper lobe of the left lung and multiple cavities, which were possible metastatic tumors. Compared with the chest CT on January 30, 2021, some of the nodules and cavities had increased (Figure 1B-D). Since then, the patient has been regularly re-examined and her condition has been stable (Figure 1E-H). The timeline of the clinical diagnosis and treatment of this patient is summarized in Figure S1.
case_images: Pathological analysis of percutaneous lung biopsy. (A) HE staining confirmed typical lung adenocarcinoma morphology, immunohistochemistry showed that (B) Ki-67 was approximately 5% positive, (C) P40 negative, and (D) TTF-1 focally positive.
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case_images: TTF-1 (Figure 2D). The patient then underwent gene mutation examination, and next-generation-sequencing (NGS) analysis of venous blood and lung tissue.
case_images: Next-generation sequencing analysis showed an FGFR2-ERC1 fusion mutation following blood analysis and lung tissue biopsy. (A) Integrative Genomics Viewer snapshot of the FGFR2-ERC1 fusion; (B) a schematic map of the FGFR2-ERC1 fusion protein domain structure.
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case_images: FGFR2-ERC1 fusion was detected only in tumor tissue DNA, and its mutant DNA fragment/total DNA fragment was 98/1629, the mutation abundance was 6.02% (Figure 3A and B).