PMC5567651_01
(a): Subcutaneous tissue with adenocarcinoma. Fig. 1: (b): Acinar and cribriform pattern.
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Histopathology revealed adenocarcinoma with acinar and cribriform pattern (Fig. 1).
(a): Tumor cells immunoreactive to Napsin A. Fig. 2: (b): Tumor cells immunoreactive to TTF-1.
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A, and cytokeratin 7 in the tumor cells (Fig. 2). These findings were consistent with lung cancer subcutaneous metastasis.
PET scan.
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After this diagnosis was made, a positron emission tomography (PET) scan was made which confirmed a hypermetabolic (SUV max: 4.73) mass in the left lower lung lobe, infrahilar, mediastinal and supraclavicular lymph nodes as well as bone involvement (Fig. 3). At the same time we immediately did a real time PCR for detection
Tumor cells are diffuse and strongly immunoreactive to anti ALK (D5F3) Ventana.
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There was strong diffuse cytoplasmic expression of the ALK protein using a rabbit monoclonal primary anti-ALK antibody (clone D5F3; Ventana Medical Systems) (Fig. 4), an OptiView 3,3'-diaminobenzidine Immunohistochemistry Detection kit and OptiView amplification kit (Ventana) and we used a fully automated assay using a BenchMark XT automated slide stainer (Ventana Medical Systems). The presence of the EML4-ALK rearrangement was verified by Fluorescence in situ hybridization (FISH), using Zytolight TriCkeck probe for ALK/EML4 (Zytovision molecular diagnostic simplified). 70% of the neoplastic cells were positive for rearrangement (Fig. 5).
EML4-ALK gene-positive translocation: split gene signal seen 70% of the nuclei, with sepaarate red and green signals (red signal: telomer side of the ALK gene, green signal: centromere side of the ALK). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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There was strong diffuse cytoplasmic expression of the ALK protein using a rabbit monoclonal primary anti-ALK antibody (clone D5F3; Ventana Medical Systems) (Fig. 4), an OptiView 3,3'-diaminobenzidine Immunohistochemistry Detection kit and OptiView amplification kit (Ventana) and we used a fully automated assay using a BenchMark XT automated slide stainer (Ventana Medical Systems). The presence of the EML4-ALK rearrangement was verified by Fluorescence in situ hybridization (FISH), using Zytolight TriCkeck probe for ALK/EML4 (Zytovision molecular diagnostic simplified). 70% of the neoplastic cells were positive for rearrangement (Fig. 5).
CT: Tumor response to Crizotinib after treatment.
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The tumor response was seen on a CT scan after 4 weeks of treatment (Fig. 6).