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case_images: Chest X-ray and CT findings. (A) Chest X-ray at the first visit to our hospital revealed bilateral diffuse shadows and a small cavity in the left lung. (B) CT at the time of EBUS-TBNA showed small, discrete, rounded pulmonary nodules of uniform size diffusely distributed throughout both lung fields. A suspected cavitary primary lesion was identified in the left upper lobe. (C) Three months after the start of treatment with alectinib, the miliary metastasis shadows had decreased considerably.
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case_images: A chest X-ray showed bilateral diffuse shadows at our hospital (Figure 1A). A CT scan revealed a 19 mm cavitary nodule in the left upper lobe and multiple small nodules with a random distribution throughout both lung fields, swollen mediastinal lymph nodes, and spinal metastasis (L4 and L5) (Figure 1B). The patient was treated with alectinib (300 mg daily), and a CT scan after three months of the treatment showed a marked improvement in the miliary pulmonary metastasis in both lungs, and the patient's total serum amylase level had decreased (Figure 1C).
case_images: Pathological findings of biopsies obtained from the mediastinal lymph node and left upper lobe of the lung. (A) Cancer cells forming solid nests and acinar structure were observed in EBUS-TBNA specimens of the mediastinal lymph node. (B) Adenocarcinoma cells forming an ambiguous acinar structure were found in TBLB specimen of the cavity in the left upper lobe of the lung. (C) ALK protein was diffusely positive in the cytoplasm of the adenocarcinoma cells in the TBLB specimens.
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case_images: Hematoxylin and eosin (HE) staining revealed adenocarcinoma cells in the EBUS TBNA specimens (Figure 2A). TBLB samples (Figure 2A and C).