PMC9393382_01
Histology sections from biopsy samples showed a spindle cell infiltrate with accompanying inflammatory stromal cell response (hematoxylin and eosin, original magnification x200).
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The biopsy of the upper lobe of the right lung revealed spindle cells arranged in a bundle and mat pattern, scattered lymphocyte infiltration, loose, and edema in some areas (Figure 1).
Immunohistochemical findings (original magnification x200). (A) Focal focus weak positive CK7; (B) strong ALK expression.
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Considering the immunohistochemical results: AE1/AE3 (-), vimentin (+), BCL-2 (-), CD34 (-), Ki67 (approximately 60% +), S-100 (-), SMA (-), TTF-1 (-), P63 (weak +), SATB2 (+), STAT6 (-), CK7 (focal weak +), ALK (D5F3) (+), and PD-L1 negative (22C3: TPS<1%) (Figure 2), which were consistent with those of malignant tumors, and a patient's pathological morphology, we suspected pulmonary mesenchymal tumor and established the diagnosis of right pulmonary inflammatory myofibroblastic tumor with bone metastasis. cT4N0M1c, the IVB stage, and the PS score was 1.
GCC2-ALK fusion was identified by next-generation sequencing.
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The sequencing results showed that there was GCC2-ALK (G19:A20) fusion (Figure 3), and the mutation abundance was 7.11%.
Rash after targeted therapy.
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However, after approximately 2 weeks of treatment, the patient developed a grade III rash (according to NCI-CTCAE standard version 5.0) appearing first on the face and gradually involving the trunk and bilateral upper and lower limbs (Figure 4), with serious pruritus.
Comparison of CT images before and after treatment with ensartinib. (A) Before ensartinib treatment; (B) 1 month after ensartinib treatment; (C) 7 months after ensartinib treatment; and (D) 11 months after ensartinib treatment.
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After 11 months of follow-up, chest CT showed that the main focus of the lung tumor was slightly advanced, but the sum of the maximum diameter of the main focus of the tumor did not increase by 20%, and an evaluation of stable disease (SD) was achieved (Figure 5).