case_images: PMC5436064_01
case_images: Initial chest computed tomography (CT) and microscopic findings of lung cancer, and the chest CT findings after 2 and 5 months of alectinib. a Multiple masses and nodules are seen in both lungs. The lesions were diagnosed as ALK-positive lung adenocarcinoma. b The lung cancer specimen shows an alveolar or sheet-like structure. c After 2 months of alectinib administration, all lesions are markedly improved. d After 5 months of alectinib administration, the lesions in the left lower lobe of the lung show regrowth (arrow).
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case_images: After further examination, he was diagnosed with adenocarcinoma of the lung (cT1aN3M1a, stage IV) (Fig. 1a, b). Two months later, a contrast-enhanced CT revealed improvement of the lung cancer lesions (Fig. 1c). Thereafter, the lesions in the left lower lobe of the lung showed regrowth (Fig. 1d). The gastric cancer was diagnosed as ALK negative using immunohistochemical staining and FISH, and the histopathological findings of the gastric cancer were different from those of the lung cancer (Fig. 1b, Fig. 2c).
case_images: Endoscopic and microscopic findings of gastric cancer. a Conventional endoscopic finding (arrows). b Dye endoscopic finding by the indigo carmine contrast method. Prior to nivolumab administration, endoscopy revealed a depressed lesion in the gastric angle region, which was diagnosed as gastric adenocarcinoma (arrows). c Microscopically, the gastric cancer specimen has an alveolar or acinus-like structure. The histopathological findings of the gastric cancer are different from those of the lung cancer.
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case_images: He underwent upper gastrointestinal endoscopy examination and was diagnosed with adenocarcinoma of the stomach (cT1bN0M0, stage IA) (Fig. 2a-c).
case_images: CT findings of lung cancer as well as endoscopy of gastric cancer after nivolumab administration. a After 5 weeks of nivolumab administration, the lung lesions show marked improvement (arrow). b Conventional endoscopic finding (arrows). c Dye endoscopic finding by the indigo carmine contrast method. After 2 months of nivolumab administration, the gastric lesion diminished in size (arrows).
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case_images: Five weeks later, the lung lesions showed marked improvement on CT examination (Fig. 3a). In addition, 2 months after the start of nivolumab administration, the gastric cancer was examined using upper gastrointestinal endoscopy, and the lesion had diminished in size (Fig. 3b, c).