PMC10111186_01
Dynamic imaging of lung lesions at different stages of treatment. (A) CT scan before alectnib treatment (March 1st, 2022); (B) CT scan after two months of alectinib treatment (April 22th, 2022); (C) CT scan after four months of alectinib treatment (June 29th, 2022); (D) CT scan after six months of alectinib treatment (June 29th, 2022); note: the red arrow marks the location of the lesion.
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A computed tomography (CT) scan showed that the middle lobe of the right lung was occupied by a mass near the hilum, with small nodules in the upper lobe of both lungs, accompanied by lymph node enlargement in area IV of the right neck ( Figure 1A ). CT scan showed that the lesion in the middle lobe of the right lung had decreased from 2.9 cm to 2.3 cm, that the lymph nodes had decreased from 1.8 cm to 1.2 cm, but that the lesions in the upper lobe of the right lung had remained unchanged, at 0.3 cm ( Figure 1B ). CT scan on June 29th, 2022, which was after four months of alectinib treatment, showed that the lesions in the middle lobe of the right lung were reduced to 1.8 cm, the lymph nodes were reduced to 1.0 cm, but the lesions in the upper lobe of the right lung were still 0.3 cm; the cough and sputum symptoms of the patient had also improved significantly. The clinical evaluation was partial response (PR) ( Figure 1C ). The patient's condition was stable at the most recent follow-up on September 14, 2022. ( Figure 1D ).
Morphology and immunohistochemistry confirmed the diagnosis of lung adenosquamous carcinoma by pathologists (A) H&E staining; (B) Positive staining of TTF-1 by immunochemistry; (C) Positive staining of Napsin A; (D) Positive staining of CK7; (E) Positive staining of CK5/6; (F) Positive staining of P63.
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Pathology staining results showed TTF-1(+), Napsin A (+), CK5/6(+), CK7(+) and P63(-) ( Figure 2 ).
A novel CPE-ALK fusion was discovered in the ASC patient; (A) Sequencing reads of ALK were shown by the Integrative Genomics Viewer. (B) Illustration of CPE-ALK fusion. (C) IHC staining indicated the expression of ALK, the specimen was stained by IHC with the anti-ALK (D5F3).
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Table S1 ). The results revealed that a novel fusion was generated by the 1-6 exons of CPE (carboxypeptidase E) and exons 20-29 of ALK, this fusion retains the ALK kinase domain ( Figure 3B ). IHC also supports an oncogenic protein generation of the CPE-ALK fusion ( Figure 3C ).