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case_images: Summary of disease course, therapies, and molecular findings. (A) The entire treatment course; (B) Chest CT scans of the primary PSC at treatment milestones; red arrows indicate nodular thickening of the pleura. (C) Pleuroscopy revealed multiple neoplasms in the right parietal pleura, visceral pleura, and phrenic pleura.
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case_images: The patient's treatment history is summarized in Figure 1A. Cooperative Oncology Group Performance Status (ECOG PS) of 3. Chest computed tomography (CT) scans revealed the presence of a mass in the right upper lobe, nodular thickening of the right pleura, and massive accumulation of pleural fluid on the right side (Figure 1B). Subsequently, a pleuroscopy was performed, which revealed multiple nodules measuring 1.0-1.2 cm in diameter on the right parietal pleura, visceral pleura, and phrenic pleura (Figure 1C). Based on these findings, the patient was diagnosed with stage IV (T4N3M1a) PSC that was positive for KIF5B-RET fusion in July 2021 (Figure 1B). After undergoing treatment for 2 months, a reduction in the size of the tumor in the right lung was observed in chest CT scans (Figure 1B). According to the RECIST criteria v1.1, the treatment response was evaluated as a partial response (Figure 1B).
case_images: Hematoxylin-eosin (HE) and immunohistochemistry staining on the biopsy sample of the right parietal pleura. The rulers in Figure 2 indicate 50 mum.
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case_images: Further examination of the biopsy sample taken from the right parietal pleura using hematoxylin-eosin (HE) examination and immunohistochemistry (IHC) staining with vimentin (+), Ki-67 (+, 90%), CAM5.2 (small part+), CK7 (small part+), and TTF1 (+), confirmed the presence of PSC (Figure 2).
case_images: The integrative genomics viewer (IGV) screenshots revealed the harboring of KIF5B-RET fusion.
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case_images: Table S1). The results of NGS revealed a canonical RET rearrangement known as KIF5B-RET (K15:R12) (Figure 3), with an allele frequency of 23.9%.