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case_images: Management of primary lung cancer and brain metastasis during icotinib treatment. Chest computed tomography (CT) on admission (July 2014) (A) showing a 3.7x2.8 cm irregularly shaped lesion in the left lower lobe (LLL); the repeated CT one month after icotinib treatment (B) showing a clear reduction in size of the lesion in the LLL; chest CT revealing dramatic shrinkage of LLL mass after one-year maintenance icotinib treatment (C); enhanced brain magnetic resonance imaging (MRI) scan on admission (July 2014) revealing brain metastasis to the right parietal lobe (D); brain MRI obtained in July 2015 showing the intracranial lesion vanished following maintenance icotinib treatment (E).
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case_images: The chest computed tomographic scan revealed a 3.7x2.8 cm mass in the left lower lung (LLL) (Figure 1). Subsequent brain magnetic resonance imaging (MRI) indicated BM (Figure 1). A repeated computed tomography (CT) after one month of therapy disclosed that the left lung mass had partially resolved (Figure 1). In July 2015, a follow-up thoracic CT performed after one year of icotinib therapy revealed dramatic shrinkage of the LLL lesion (Figure 1).
case_images: Histology of the primary lung cancer. The hematoxylin and eosin staining revealed that the left lower lobe lesion was a moderately differentiated adenocarcinoma (magnification x100).
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case_images: A bronchoscopic biopsy was performed, and histopathologic examination confirmed NSCLC with a moderately differentiated tumor histology favoring adenocarcinoma (Figure 2).
case_images: Direct Sanger sequencing and fluorescence in situ hybridization (FISH) analysis of the biopsied lung lesion. A mutant form of EGFR L858R in exon 21 (A) was identified in the left lower lobe (LLL) lesion. Anaplastic lymphoma kinase (ALK) rearrangement was detected by FISH analysis using break-apart probes. Samples are considered to be FISH positive if split ALK 5' and 3' probe signals or isolated 3' signals are detected in at least 15% of counted tumor cells. Approximately 22% of lung adenocarcinoma cells indicate ALK rearrangement, as demonstrated by split red/green signals (B).. Abbreviation: EGFR, epidermal growth factor receptor.
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case_images: EGFR mutation and ALK translocation status were identified by direct Sanger sequencing, real-time polymerase chain reaction, and fluorescence in situ hybridization (FISH) analysis, and both were found to be positive (EGFR exon 21 L858R and ALK FISH positive 22% of the cells) (Figure 3A and B).