case_images: PMC6225853_01
case_images: Computed tomography (CT) scans show (A) prior treatment of the lung tumor. (B) Cisplatin+cyclophosphamide regimen after chemotherapy. (C) Pemetrexed combined with cisplatin regimen after chemotherapy. (D) Intestinal obstruction after pemetrexed combined with cisplatin regimen.
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case_images: PMC6225853_01_ott-11-7821Fig1.jpg
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case_images: A computed tomography (CT) scan showed a mass in the right lower lung and mediastinal lymph node enlargement (Figure 1A). The clinical stage was cT2N2M0 (stage IIIA) according to the seventh edition of TNM staging. He underwent two cycles of chemotherapy (docetaxel, 75 mg/m2 on days 1 and 8; and carboplatin area under curve =5 on day 1 [DP]). The disease progressed after two cycles of DP chemotherapy (Figure 1B), thus the chemotherapy regimen was changed to pemetrexed (500 mg/m2 on day 1), combined with cisplatin (25 mg/m2 on days 1-3) plus bevacizumab (5 mg/kg on day 1). Lung lesion control was stable (Figure 1C); however, after three cycles the patient had bloating and decreased flatus, and an abdominal CT scan showed an intestinal effusion with local intestinal obstruction (Figures 1D and 3A).
case_images: (A) Hematoxylin and eosin (H&E) staining revealed adenocarcinoma (H&E x100). Immunohistochemical (IHC) analysis revealed that the lung tumor cells were positive for Napsin A (B) and TTF-1 (C) (H&E x100).
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case_images: PMC6225853_01_ott-11-7821Fig2.jpg
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case_images: TTF-1 and Napsin A and negative for CK5/6 and P40 (Figure 2).
case_images: Computed tomography (CT) scan shows (A) postoperative intestinal obstruction and crizotinib before treatment. (B) Two months after crizotinib treatment. (C) Disease progression after 7 months of crizotinib treatment.
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case_images: PMC6225853_01_ott-11-7821Fig3.jpg
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case_images: Lung lesion control was stable (Figure 1C); however, after three cycles the patient had bloating and decreased flatus, and an abdominal CT scan showed an intestinal effusion with local intestinal obstruction (Figures 1D and 3A). The efficacy was considered to be a partial response (PR) according to the Response Evaluation Criteria 1.1 in Solid Tumors (Figure 3B). The disease progressed after 7 months (Figure 3C), and other treatment was initiated.
case_images: Schema shows tumor with drivers of ROS1 gene positive by RT-PCR. Purple, brown, and orange represent the sample, positive control, and negative control, respectively.. Abbreviation: RT-PCR, real-time PCR.
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case_images: Using an real-time PCR (RT-PCR) assay (ACCB Biotech, Beijing, China), we found that the tumor had an ROS1 fusion (Figure 4).