case_images: PMC10601751_01
case_images: a Brain magnetic resonance imaging (MRI) before brain tumorectomy shows solitary tumor in the cerebellum. b, c Chest computed tomography (CT) before first-line treatment shows a mass shadow in the right lower lobe and mediastinal lymph nodes. d Brain MRI 1 month after brain tumorectomy shows metastatic brain tumor re-enlargement. e, f Abdominal CT before first-line treatment shows metastases to the bilateral adrenal glands and left ilium.
case_images: cro-2023-0016-0001-532101_F01.jpg
case_images: PMC10601751_01_cro-2023-0016-0001-532101_F01.jpg
case_images: F1
case_images: Brain magnetic resonance imaging (MRI) revealed a solitary cerebellar tumor, which prompted the patient's hospital admission (Fig. 1a). Chest computed tomography (CT) showed a mass shadow in the right lower lobe and mediastinal lymph nodes, which suggests that the patient had a lung cancer lesion that metastasized to the brain, which prompted her admission in our hospital (Fig. 1b, c). The metastatic brain tumor continued to enlarge 1 month after tumorectomy (Fig. 1d). IVB ADR BRA OSS OTH (according to the eighth edition of the TNM Classification of Malignant Tumors) (Fig. 1e, f). Thus, pembrolizumab monotherapy (200 mg intravenously every 3 weeks) was initiated as first-line treatment in January 2022. In addition, stereotactic radiotherapy (35 Gy delivered in five fractions) was performed as treatment for metastatic brain tumors.
case_images: a Histological staining of the brain tumor tissue shows malignant spindle cells (hematoxylin-eosin staining, magnification x20). b Immunohistochemistry analysis of the brain tumor detected the high expression of echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase.
case_images: cro-2023-0016-0001-532101_F02.jpg
case_images: PMC10601751_01_cro-2023-0016-0001-532101_F02.jpg
case_images: F2
case_images: Histological examination of the brain tumor showed malignant spindle cells and absence of carcinomatous components (Fig. 2a). ALK was detected through immunohistochemistry of the brain tumor tissue (Fig. 2b). Therefore, alectinib (300 mg twice daily) was initiated as second-line treatment in February 2022. After the initiation of alectinib therapy, the patient's headache and nausea disappeared, and the PS score improved to 2.
case_images: Chest CT 2 months after second-line alectinib treatment (3 months after initiation of first-line treatment). a The mass shadow in the right lower lobe had been reduced. b A new nodule shadow was observed in the right lower lobe. c, d Brain magnetic resonance imaging (MRI) 2 months after initiating second-line alectinib treatment (3 months after initiation of first-line treatment) shows multiple brain metastases. e, f Brain MRI 4 months after initiating third-line lorlatinib treatment (7 months after initiation of first-line treatment) shows growth of tumors in the right frontal and left occipital lobes.
case_images: cro-2023-0016-0001-532101_F03.jpg
case_images: PMC10601751_01_cro-2023-0016-0001-532101_F03.jpg
case_images: F3
case_images: In April 2022 (2 months after the initiation of alectinib therapy), chest CT showed a reduction in the mass shadow in the right lower lobe; however, a new nodule shadow was noted in the right lower lobe (Fig. 3a, b). The brain MRI revealed multiple brain metastases (Fig. 3c, d). In August 2022 (4 months after the initiation of lorlatinib), brain MRI showed tumor growth in the right frontal and left occipital lobes (Fig. 3e, f).