case_images: PMC5878901_01
case_images: CT findings before and after the treatment. (a) Chest CT at admission. It showed a tumor in the left lower lobe of the lung with mediastinal lymphadenopathy, pleural dissemination, and multiple pulmonary metastases in both of the lungs. (b) CT revealed dramatic tumor reduction in the primary and metastatic lesions, and this had maintained after 9 months since we started the treatment.
case_images: CRIONM2018-4172721.001.jpg
case_images: PMC5878901_01_CRIONM2018-4172721.001.jpg
case_images: fig1
case_images: The patient also had mediastinal lymphadenopathy, pleural dissemination, and multiple pulmonary metastases throughout both lungs (Figure 1(a)). After 9 months, a follow-up CT scan revealed remarkable size reductions in the primary lesion (38 mm to 7 mm, to be specific) and regression of mediastinal lymphadenopathy, and multiple pulmonary metastases had been maintained (Figure 1(b)), which we diagnosed as good partial response, according to the RECIST criteria.
case_images: Pathological examinations. (a) Hematoxylin and eosin staining showed moderately differentiated malignant cells with abundant cytoplasm connected with intercellular bridge. Immunohistochemical staining revealed that the tumor cells were strongly positive for p40 (b) and CK5/6 (c). (d) Fluorescence in situ immune-hybridization signals of ALK. Split red and green signals can be observed.
case_images: CRIONM2018-4172721.002.jpg
case_images: PMC5878901_01_CRIONM2018-4172721.002.jpg
case_images: fig2
case_images: Keratinization was not clear (Figure 2(a)). Fluorescence in situ hybridization confirmed the presence of ALK gene rearrangement with a rearrangement-positive cell rate of 95% and higher (Figure 2(d)).