PMC9577405_01
(A) Chest and abdomen computed tomography scans revealing the clinical response to alectinib. (B) Bone scan with technetium 99m-methyl diphosphonate prior to alectinib treatment revealing radioactive accumulation in the bones (red arrow).
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A chest CT scan revealed multiple nodules, with the largest diameter measuring 27 mm and multiple lymph node involvement around the right hilum ( Figure 1A ). Enhanced magnetic resonance imaging of the brain showed no abnormalities. Emission CT revealed abnormal radioactive concentrations in the bone, which were then diagnosed as multiple bone metastases ( Figure 1B ). At the 2- and 4-months follow-up, a CT scan revealed a remarkable reduction of the tumors in the chest, liver, pancreas, adrenal gland, and mediastinal lymph node ( Figure 1A ).
Immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) results of the biopsy specimen. (A) Hematoxylin and eosin staining revealing an adenocarcinoma. (B-F) IHC results of TTF-1, Hepa, CK-7, PD-L1, and ALK expression detected by D5F3 IHC assay. (G) FISH showed ALK gene rearrangement positive signal (one red and one yellow, indicated by white arrows).
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A cytologic examination of the biopsy specimen showed adenocarcinoma cells ( Figure 2A ), which tested positive for cytokeratin 7 and thyroid transcription factor-1 and negative for Hepa in immunohistochemistry (IHC) ( Figure 2B-D ). TP53) (Guangxi Medical University REXPLO Medical Laboratory, Nanning, China). NGS revealed a novel ALK fusion, namely, junctional sarcoplasmic reticulum protein 1 (JSRP1) intergenic region-ALK fusion (Jintergenic: A20) (abundance: 37.2%). The microsatellite status was microsatellite instability-stable, and the tumor proportion score of PD-L1 (antibody: 28-8) was greater than 50% ( Figure 2E ). IHC (Ventana D5F3) and fluorescence in situ hybridization (FISH) of the biopsy specimen were performed, which confirmed a marked ALK fusion at the protein and DNA levels ( Figures 2F, G ).