PMC9713802_01
Ultrasound images of the patient. (A) Enlarged lymph nodes in the left neck in January 2017. (B) The cervical lymph nodes were reduced during therapy in January 2019. (C) The cervical lymph nodes were enlarged for the second time in March 2020.
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Some of these areas exhibited a strong mottling echo (Fig. 1). During therapy, the neck mass was significantly reduced in size (Fig. 1). In March 2020, the cervical lymph nodes were enlarged for the second time, thus indicating disease progression (Fig. 1).
PET-CT images of the patient. (A) Whole-body coronal PET-CT image. (B) FDG uptake (arrow) in the left breast lesion. (C) FDG uptake (arrow) in the left cervical lymph nodes. (D) Small nodule in the right lung without metabolic activity. PET-CT, positron emission tomography-computed tomography; FDG, fluorodeoxyglucose.
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PET-CT showed that the aforementioned lesions in the breast and neck were metabolically active (Fig. 2). The right lung and upper lobe of the left lung presented with several small nodules without metabolic activity, thus indicating inflammation (Fig. 2).
Histopathological, immunohistochemical and fluorescence in situ hybridization characterization of the breast, lymph node and lung lesions. (A) H&E staining of the breast lesion (magnification, x200). (B-E) Immunohistochemical expression of (B) estrogen receptor, (C) progesterone receptor, (D) gross cystic disease fluid protein 15 and (E) CA15-3 in the breast lesion (magnification, x100). (F) H&E staining of the lymph node lesion (magnification, x200). (G-J) Immunohistochemical expression of (G) CK7, (H) Napsin A, (I) TTF1 and (J) CA15-3 in the lymph node lesion (magnification, x100). (K) H&E staining of the lung lesion (magnification, x200). (L and M) Immunohistochemical expression of (L) CK7 and (M) TTF1 in the lung lesion (magnification, x100). (N) KIF5B-RET fusions in the lymph node lesion (magnification, x1,000). (O) KIF5B-RET fusions in the lung lesion (magnification, x1,000). (A-J) July 2017. (K-M) November 2021. (N and O) August 2022. H&E, hematoxylin and eosin; CK, cytokeratin; TTF1, thyroid transcription factor 1; CA15-3, cancer antigen 15-3; KIF5B, kinesin family member 5B; RET, ret proto-oncogene.
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I; Fig. 3). In addition, morphology in the left cervical lymph node revealed a poorly differentiated tumor in the lymphoid tissue and immunohistochemical results were of little help in identifying the source of the tumor (Table I; Fig. 3). A right lung biopsy revealed a poorly differentiated carcinoma and the immunohistochemistry results supported the diagnosis of primary lung adenocarcinoma (Table I; Fig. 3).