case_images: PMC11228237_01
case_images: (A) Treatment flow chart. (B) CT and ultrasound showed the left pleural effusion. (C) CT indicated CR. (D) CT showed a lower lobe nodule of the left lung with a maximum length of 1.3 cm and ultrasound showed the left pleural effusion. (E) CT indicated CR. (F) CT and ultrasound showed the left pleural effusion. (G) CT indicated PR. (H) CT showed the mass on his left posterior chest wall. (I) CT indicated PR. (J) H&E, hematoxylin and eosin stain of the metastatic mass. CT, computed tomography.
case_images: fonc-14-1419306-g001.jpg
case_images: PMC11228237_01_fonc-14-1419306-g001.jpg
case_images: f1
case_images: In December 2015, a 57-year-old male presenting with chest pain and post-activity fatigue was diagnosed with left lower lung adenocarcinoma (cT1N2M1a stage IVA) upon identification of cancer cells in his left pleural effusion ( Figure 1B ). An initial complete response (CR) was observed by 1th January 2016 ( Figure 1C ) and bi-monthly follow-ups showed no drug related adverse effects including rash or hypertension. Meanwhile, computed tomography (CT) showed a lower lobe nodule of the left lung with a maximum length of 1.3 centimeters ( Figure 1D ). On 14th February 2019, the patient achieved CR. ( Figure 1E ) and exhibited a PFS2 of 29 months. April 2021, an ultrasound scan and cytological examination confirmed recurrent massive malignant left pleural effusion ( Figure 1F ). A second PD was considered for the patient and follow-up circulating tumor DNA sequencing of the pleural fluid identified two ALK point mutations (F1174C exon23, V1180L exon23) on Illumina high-throughput sequencing platform. The patient achieved a partial response (PR) on 10th June 2021 ( Figure 1G ) and exhibited a PFS3 of 33 months. On 15th January 2024, the patient presented at hospital due to a mass he found on his left posterior chest wall ( Figure 1H ). A percutaneous aspiration biopsy of this mass confirmed metastases ( Figure 1J ) and excluded the possibility of pathological transformation such as the squamous cell carcinoma or small cell carcinoma. On 22th January 2024, the CT revealed that the patient had achieved a PR after one cycle of chemotherapy and local radioactive therapy ( Figure 1I ). Treatment flow chart is presented below ( Figure 1A ) and the ALK-related genetic tests results are shown in  Table 1 .