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case_images: Schematic of patients' treatment histories. (A) The treatment timeline of the patient. (B) Images of the chest CT are provided with lung tumors indicated with red arrows.
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case_images: Her chest computed tomography (CT) scan revealed a 34 mm x 37 mm x 56 mm mass in the right upper lobe with metastases to mediastinal and right hilar lymph nodes (Figure 1A and B). B). Based on the imaging examinations, histopathology and immunohistochemical profile, the patient was diagnosed with stage IV (cT3N3M1c) lung adenocarcinoma according to UICC 8th edition TNM staging (Figure 1A). Therefore, a combined treatment of crizotinib (250 mg bid) and maintenance chemotherapy with pemetrexed (0.8 g on d1, q4w) were administrated on May 27, 2019 and achieved a partial response (PR), as indicated by chest CT scan one month later which showed a remarkable shrinkage of the right upper lung lesion and multiple nodules in the two lungs (Figure 1B). Since the monthly chest CT scan in the following 6 months indicated a remarkable shrinkage of the right upper lung lesion and multiple nodules in the two lungs (Figure 1B), the patient was only given crizotinib as maintenance treatment on October 31, 2019. In July 2020, the patient's chest CT scan showed that multiple nodules in both lungs were benign nodules (Figure 1B).
case_images: Pathology results. (A and B) Hematoxylin-eosin staining of endobronchial ultrasound-guided transbronchial needle aspiration biopsy specimen showed lung adenocarcinoma (10x).
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case_images: Sequencing reads of IGR and ALK were visualized by the Integrative Genomics Viewer (IGV). The schematic below shows the IGR (upstream YPEL5-) ALK fusion.
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case_images: Technology Inc., Nanjing, Jiangsu, China) of her aspiration biopsy identified an IGR (chr2: 30,316,870)-ALK fusion (Figure 3), but no other oncogenic alterations were found.