case_images: PMC6501700_01
case_images: Biopsy pathology and IHC examination. (A) Thoracoscopic photography. Multiple nodular lesions were found in right pleural cavity under thoracoscopy. (B) Histopathological examination (H&E). The pleural tissue showed neoplasia, large nuclei, deep staining, and strong heterogeneity, which was similar to sarcoma. (C) IHC, DAB staining. It showed positive CK67 staining in tumor tissue. (D) IHC, DAB staining. It showed strong positive EML4-ALK staining in tumor tissue.. Abbreviation: IHC, immunohistochemistry.
case_images: ott-12-3321Fig1.jpg
case_images: PMC6501700_01_ott-12-3321Fig1.jpg
case_images: f1-ott-12-3321
case_images: Biopsy pathology and immunohistochemistry examination can be seen in Figure 1. Thoracoscopy revealed multiple nodular lesions in the right pleural cavity (Figure 1A). PSC was confirmed through biopsy and histopathology (Figure 1B). ALK rearrangement was also further confirmed by examining ALK expression (clone D5F3; Hoffman-La Roche Ltd., Basel, Switzerland) using IHC (Figure 1D) and FISH assay (Figure 3B).
case_images: Images of CT and SPECT. (A) CT image. After thoracoscopy, most pleural effusion was drained. CT revealed spot- and piece-shaped shadows, showing multiple solid lesions in the right lung. (B) SPECT image. General bone scan showed multiple metabolic abnormalities and concentration points. (C) CT image. Pleural effusion increased further, and the pleura became much thickened with multiple nodules.. Abbreviations: CT, computed tomography; SPECT, single-photon emission CT.
case_images: ott-12-3321Fig2.jpg
case_images: PMC6501700_01_ott-12-3321Fig2.jpg
case_images: f2-ott-12-3321
case_images: SP13), WT1 (clone WT49), and MC (clone HBME-1). After thoracoscopy, CT revealed spot- and piece-shaped shadows and multiple solid lesions in the right lung as well as nodular pleural thickening (Figure 2A). Moreover, the enlargement of mediastinal lymph nodes was also observed. Single-photon emission CT (SPECT) scan revealed multiple bone metastases (Figure 2B). A repeat CT showed increased pleural effusion with further thickening of the pleura and presence of multiple nodules (Figure 2C).
case_images: (A) Sanger's sequencing further confirms KRAS exon 2 mutation (the arrow shows code 12 GGT to GAT). (B) ALK rearrangement revealed by the split of red and green probes in FISH assay with 75% of rearranged cells.
case_images: ott-12-3321Fig3.jpg
case_images: PMC6501700_01_ott-12-3321Fig3.jpg
case_images: f3-ott-12-3321
case_images: We further verified the KRAS exon 2 mutation by performing Sanger's sequencing to analyze the KRAS gene sequence (an arrow shows code 12 GGT to GAT; Figure 3A). ALK rearrangement was also further confirmed by examining ALK expression (clone D5F3; Hoffman-La Roche Ltd., Basel, Switzerland) using IHC (Figure 1D) and FISH assay (Figure 3B).