PMC8024693_01
Computed tomography shows right upper nodule (A) and balky mediastinal lymphadenopathy (B). Bone scintigraphy (C) and brain magnetic resonance imaging (D, E) show multiple bone and brain metastases. Histopathology of a lymph node revealed adenocarcinoma (F, x200 haematoxylin and eosin). Immunohistochemistry shows positive staining of ALK fusion gene (G, x100).
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Initial evaluation suggested advanced right upper lung cancer with multiple brain and bone metastases (Fig. 1A-E). The mediastinal lymph node specimen obtained by endobronchial ultrasound-guided transbronchial needle aspiration demonstrated adenocarcinoma (Fig. 1F) with EGFR mutation (L858R point mutation) and ALK rearrangement (Fig. 1G).
Computed tomography shows remarkable remission of right upper nodule (A) and mediastinal lymphadenopathy (B) after osimertinib induction.
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Three weeks after osimertinib induction, enhanced chest computed tomography images revealed tumour regression (Fig. 2A and B).