PMC6019858_01
Left, Sagittal T2-weighted MRI showed a mass measuring 5 cm in diameter at the urinary bladder dome with extramural invasion. Middle, The left ischial bone presented high intensity on axial T2-weighted image. Right, Coronal T2-weighted imaging showed local high-intensity area in the right humerus.
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T2-weighted images and diffusion-weighted images (see Fig. 1). Thus, bone metastases was suspected.
Left, Before treatment, CT showed a mass measuring 49 mm in diameter. Right, After treatment, the tumor size reduced to 25 mm.
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After 2 months, CT images showed a 48% reduction in the sum of the longest diameter (see Fig. 2).
Cystoscopy; a nodular tumor at the bladder dome.
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Cystoscopy showed a nodular tumor at the bladder dome (see Fig. 3); thus, we decided that we could resect the tumor with enough surgical margin and preserve adequate capacity of the bladder after surgery.
Left, Fascicular proliferation of monotonous spindle cells within myxoid stroma. Right, A hyalinised area was focally present, which may indicate changes associated with crizotinib therapy.
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Histological examination demonstrated intersecting fascicles of spindle cell proliferation admixed with a few inflammatory cells within a myxoid stroma (see Fig. 4).
Left, Immunohistochemical staining showed that the tumor cells were positive for ALK. Right, FISH showed positive evidence of ALK rearrangement (arrows indicate rearranged ALK signals).
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Immunohistochemical staining showed that the spindle cells were positive for ALK (5A4, Abcam, Cambridge, UK), and fluorescence in situ hybridization using a break-apart probe (Vysis ALK Break Apart FISH Probe Kit, Abbott Molecular, Abbott Park, IL) showed ALK rearrangement (see Fig. 5).