case_images: PMC6333155_01
case_images: Main lesion with positive positron emission tomography-computed tomography (PET-CT).
case_images: imcrj-12-015Fig1.jpg
case_images: PMC6333155_01_imcrj-12-015Fig1.jpg
case_images: f1-imcrj-12-015
case_images: Positron emission tomography-computed tomography (PET-CT) was performed with positive 9SUV grade from the main lesion and 4.5SUV from the station 11 left; there were no other pathological lymph nodes according to the PET-CT (Figures 1-2).
case_images: Positron emission tomography-computed tomography with lymph node station number 11 left (arrow).
case_images: imcrj-12-015Fig2.jpg
case_images: PMC6333155_01_imcrj-12-015Fig2.jpg
case_images: f2-imcrj-12-015
case_images: Positron emission tomography-computed tomography (PET-CT) was performed with positive 9SUV grade from the main lesion and 4.5SUV from the station 11 left; there were no other pathological lymph nodes according to the PET-CT (Figures 1-2).
case_images: Left, computed tomography of the thorax with lymph node station number 11 left; middle, the carina of the left upper and lower lobe; and right, the lymph node 22 left with the convex probe ultrasound.
case_images: imcrj-12-015Fig3.jpg
case_images: PMC6333155_01_imcrj-12-015Fig3.jpg
case_images: f3-imcrj-12-015
case_images: Biopsy was performed from the main lesion with CT guidance, and convex probe EBUS was used for additional staging of the mediastinum (Figure 3).
case_images: ALK gene rearrangement by FISH in the case of lung adenocarcinoma with positivity in 31% of neoplastic cells. FISH, ZytoLight SPEC ALK dual color, break apart probe (ZytoVision GmbH).. Abbreviation: ALK, anaplastic lymphoma kinase; FISH, fluorescence in situ hybridization.
case_images: imcrj-12-015Fig4.jpg
case_images: PMC6333155_01_imcrj-12-015Fig4.jpg
case_images: f4-imcrj-12-015
case_images: Additionally, fluorescence in situ hybridization (FISH) was performed and revealed ALK translocation/fusion (Figure 4).
case_images: Positron emission tomography-computed tomography with the disease relapse lesion under the diaphragm 1.2 cm.
case_images: imcrj-12-015Fig5.jpg
case_images: PMC6333155_01_imcrj-12-015Fig5.jpg
case_images: f5-imcrj-12-015
case_images: Sixteen months after surgery, a small lesion of 1.2 cm was observed right under the diaphragm and next to the vertebra with PET-CT 6SUV and biopsy was performed (Figure 5).
case_images: PD-L1 expression to the relapse site (nodule under the diaphragm).. Notes: (A) Programmed death-ligand 1-positive case with whole membranous staining (intense 1+ and 2+) in 90% of neoplastic cells; (B) hematoxylin/eosin of the same case (undifferentiated lung adenocarcinoma), magnification x100.
case_images: imcrj-12-015Fig6.jpg
case_images: PMC6333155_01_imcrj-12-015Fig6.jpg
case_images: f6-imcrj-12-015
case_images: Again, it was NSCLC adenocarcinoma with next generation sequencing negative for any gene mutation and negative ALK translocation/fusion with FISH; however, PD-L1 expression was 90% (Figure 6).
case_images: Main tumor PD-L1 expression after surgery.. Notes: (A) Programmed death-ligand 1-negative case without any membranous, whole or partially positive, magnification x100; (B) hematoxylin/eosin of the same case with numerous neoplastic adenocarcinoma cells, magnification x100.
case_images: imcrj-12-015Fig7.jpg
case_images: PMC6333155_01_imcrj-12-015Fig7.jpg
case_images: f7-imcrj-12-015
case_images: We performed PD-L1 in the main tumor lesion and the expression was 0% (Figure 7).