case_images: PMC8349051_01
case_images: Imaging findings at the time of initial diagnosis A, B) Chest computed tomography scan shows a primary lesion in the right upper lobe and a massive pericardial effusion. C, D) F18 fluorodeoxyglucose positron emission tomography scan shows uptake by the primary lesion, mediastinal lymph nodes, and pelvic bone.
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case_images: Multiple metastatic lung cancer (cT4N3M1c) was diagnosed by computed tomography and positron emission tomography (Fig. 1).
case_images: Computed tomography findings A) Progression of the primary lesion after 4 years of alectinib treatment. B) Partial response during cytotoxic chemotherapy for SCLC. C) Progression of the primary lesion after 2 years of cytotoxic chemotherapy for SCLC. D) Partial response after alectinib rechallenge.
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case_images: After 4 years of alectinib treatment, no metastases appeared, but the primary lesion progressed (Fig. 2A). TTF-1 (-), and ALK-1 (-), and the adenocarcinoma components were CD56 (-), synaptophysin (-), TTF-1 (+), and ALK-1 (+) (Fig. 3A). Two regimens of cytotoxic chemotherapy for SCLC (cisplatin plus irinotecan as the sixth-line treatment and amrubicin as the seventh-line treatment) showed a partial response (Fig. 2B), but serum tumor markers such as carcinoembryonic antigen (CEA) and sialyl-Lewis X-i antigen (SLX) increased gradually (Fig. 4). Imaging findings showed progression of the primary lesion and multiple brain metastases (Fig. 2C). ALK-1 (+), and disappearance of the SCLC component (Fig. 3B). Alectinib was re-administered, which resulted in a partial response and decreased CEA and SLX levels (Fig. 2, Fig. 4).
case_images: Pathological findings A) The second biopsy sample shows combined small cell carcinoma. SCLC components are positive for CD56 and synaptophysin, and adenocarcinoma components are positive for TTF-1 and ALK-1. B) The third biopsy sample shows only adenocarcinoma without SCLC components. Immunohistopathological analysis shows positive staining for TTF-1 and ALK-1, but negative staining for CD56 and synaptophysin.
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case_images: fig3
case_images: TTF-1 (-), and ALK-1 (-), and the adenocarcinoma components were CD56 (-), synaptophysin (-), TTF-1 (+), and ALK-1 (+) (Fig. 3A). Two regimens of cytotoxic chemotherapy for SCLC (cisplatin plus irinotecan as the sixth-line treatment and amrubicin as the seventh-line treatment) showed a partial response (Fig. 2B), but serum tumor markers such as carcinoembryonic antigen (CEA) and sialyl-Lewis X-i antigen (SLX) increased gradually (Fig. 4). ALK-1 (+), and disappearance of the SCLC component (Fig. 3B). Alectinib was re-administered, which resulted in a partial response and decreased CEA and SLX levels (Fig. 2, Fig. 4).