PMC6010640_01
Frontal anteroposterior chest roentgenography revealing right middle and lower lobe atelectasis, as well as infiltration into the left lung.
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Chest roentgenography revealed right-sided white-out hemithorax (Fig. 1).
Frontal view of contrast-enhanced whole body computed tomography (mediastinal window) revealing a large mass with inhomogeneous enhancement (arrow), consolidation with air bronchogram (arrowhead), and pleural effusion in the right lung. Multiple osteolytic lesions, especially in the spine and pelvic bones, are also visible.
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Contrast-enhanced whole-body computed tomography (CT) revealed a large mass with inhomogeneous enhancement in the right lung, as well as pleural effusion, consolidation in both lungs, and multiple osteolytic lesions, mainly in the spine and pelvic bones (Fig. 2).
The tumor biopsy was directed by diffusion-weighted image sequences and guided by computed tomography. (A) A fusion image of axial T1-weighted and diffusion-weighted image sequences shows a high signal intensity area in the right iliac bone. It suggests that the area was more cellular and viable than the other pelvic bone osteolytic lesions. (B) The tumor biopsy was directed to the high signal intensity area with the patient in a prone position (arrow; biopsy needle). (Note: this image is upside down).
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T1-weighted MRI (Fig. 3).
Histopathological examination of the tumor biopsy shows adenocarcinoma (A, hematoxylin and eosin staining). The tumor cells expressed thyroid transcription factor-1 (B) and anaplastic lymphoma kinase protein (C). (All microphotographs x 200).
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The specimen was identified as an adenocarcinoma that was found to be anaplastic lymphoma kinase-positive by immunohistochemistry (Fig. 4); break-apart fluorescence in situ hybridization confirmed ALK rearrangement. The patient's respiratory condition gradually improved with antibiotics and supportive treatment, and he was extubated on day 9.