PMC8256165_01
Timeline of the patient's chest CT scan showed the obvious remission of the patient' s diffused lesions in the bilateral lung and enlarged lymph nodes after crizotinib treatment: (A) 7 July, 2020 (baseline), (B) 24 August, 2020, (C) 22 September, 2020, (D) 14 December, 2020, (E) 25 April, 2021.
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Chest computed tomography (CT) scan showed diffuse round high-density lesions with small pleural effusion in the lungs bilaterally, accompanied by multiple enlarged LNs in the mediastinum and right supraclavicular area ( Figure 1A ). She stopped molecular targeted therapy for 2 weeks because of severe hypoalbuminemia and secondary bilateral pleural effusion which might be relative to crizotinib ( Figure 1C ). The tumor lesions and enlarged LNs further reduced after 4 months ( Figure 1D ). We are still following up with the patient, and she has remained PR for 9 months till the last follow-up ( Figure 1E ).
The patient' s PET/CT scan showed diffused lesions with increased FDG uptake like chest CT located in the lung and LNs without distal metastasis.
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Positron emission tomography (PET)-CT showed no distal metastasis, which showed similar lesions with increased Fluorodeoxyglucose (FDG) uptake as chest CT in the lung and LNs (N2, N3) ( Figure 2 ).
Pathological and molecular examinations of the case. HE staining showed the microscopic appearance of squamous cell carcinoma with nests of polygonal cells with pink cytoplasm and distinct cell borders (x200). Immunostaining of lung tissue and supraclavicular lymph node showed strongly positive for p40 and CK5/6, and negative for TTF-1 and Napsin A (x200). ARMS assay of lung tissue showed ROS1 rearrangement.
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Immunohistochemical staining confirmed the diagnosis of SCC with positive P40 and CK5/6, negative transcription factor-1 (TTF-1), and napsin A ( Figure 3 ). Genetic status, including EGFR, ALK, ROS1, KRAS, BRAF, RET, MET, HER2, NRAS, and PI3KA presence, was detected by amplification refractory mutation system (ARMS) with AmoyDx Mutations Detection Kit (Amoy Diagnostics Co., Ltd., Xiamen, China), revealing that the tumor harbored ROS1 rearrangement ( Figure 3 ).