case_images: PMC10450948_01
case_images: The lesions on computed tomography. (A, B) were before treatment of aletinib. (C, D) were partial response after 8 weeks treatment of aletinib. (E, F) were progressive disease after 11 months treatment of ALK-TKI.
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case_images: A contrast-enhanced computed tomography (CT) scan of the chest confirmed the mass in the upper lobe of the left lung ( Figures 1A, B ). Eight weeks after this administration, the efficacy was evaluated as a partial response (PR) as CT imaging showed the shrinkage of the lung ( Figures 1C, D ). In addition, the chest/abdomen/pelvic CT scans indicated the enlargement of the primary lesions and metastatic lesions ( Figures 1E, F ).
case_images: A comparison of the Hematoxylin and eosin staining results from the metastatic subcutaneous nodules and primary lung tumor. Immunohistochemical show that the lung tumor biopsy is (A) squamous cell cancer (B) positive for p40 (C)negative for TTF1 (D) positive for CK7, and metastatic subcutaneous nodules are (E) adenocarcinoma (F) negative for TTF1 (G) negative for Napsin A (H) positive for CK7. (I) Variant allele frequencies (VAF) of gene mutations in different morphological sites. (J) Flow chart of patient treatment.
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case_images: P40 ( Figures 2A-D ). The pathological slices of the subcutaneous nodules of the scalp were borrowed from Zhuhai Third People's Hospital. Pathological diagnosis in our hospital confirmed they were medium-differentiated ADC with a conspicuous acinar growth pattern and extracelluar mucus production ( Figure 2E ). Immunohistochemically, the nodules were negative for TTF-1, Napsin A, but showed positive expression of CK7 ( Figures 2F-H ). FOXP1, CIC, and FARS1 gene were 45.21%, 35.20%, 38.82%, 40.16%, and 24.35%, respectively, while in the SQCC of main lung tumor, they were 76.33%, 56.55%, 54.47%, 49.98%, and 0 correspondingly ( Figure 2I ). Finally, the patient was diagnosed with clinical stage IVB, T4N3M1c of the lung cancer possessing an A flowchart of the patient's treatment timeline is provided in  Figure 2J .