PMC4712969_01
CT scans show: before crizotinib therapy (A-C); CT of the chest revealed the recurrence after 2 months of crizotinib (D-F).. Abbreviation: CT, computed tomography.
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Cancer Hospital. Computed tomography (CT) scans revealed a mass at right lung and pleural metastasis (T2aNxM1a stage IV) (Figure 1A-C). Chest CT scan images demonstrated increase in tumor size and metastases (Figure 1D-F).
Needle biopsy showed a poorly differentiated carcinoma (HE, x200) (A) and FISH analysis of the lung tumor specimen revealed cells with characteristic ALK translocation (B).. Abbreviations: ALK, anaplastic lymphoma kinase; FISH, fluorescence in situ hybridization; HE, hematoxylin and eosin.
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Hematoxylin and eosin (H&E) staining showed a typical morphology of ADC cell (Figure 2A). ARMS (AmoyDx, Xiamen, China). ALK gene rearrangement was detected by fluorescence in situ hybridization (FISH), the split-apart signals for ALK gene translocation was 21% (Figure 2B).
CT scans show: after the course of chemoradiotherapy (A-C); CT of the chest revealed the recurrence after the course of chemoradiotherapy (D-F); CT scan of chest after 1 month of icotinib treatment (G-I).. Abbreviation: CT, computed tomography.
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Unfortunately, during routine examination, the presence of pleural effusion in right lung on CT scan (Figure 3A-C) indicated cancer progression in May 2015. The pleural effusion could not be controlled after pleural effusion drainage (Figure 3D-F). After 1 month, chest CT scan images demonstrated decrease in tumor size (Figure 3G-I).
EGFR Exon 19 deletion (E746-A750del) in next-generation sequencing in plasma (the blank region expressed base deletion and at the bottom of bull lines indicated E to A deletion).. Notes: *A guidance function. The dark gray region represents an expanding fold.. Abbreviation: EGFR, epidermal growth factor receptor.
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Then deletion in exon 19 was found by next-generation sequencing (NGS) in plasma (geneseeq one, Nanjing, China) (Figure 4) and other mutations were not harbored such as other EGFR mutations, B-cell lymphoma 2 (BCL2)-like 11 deletion (BIM), ALK-fusion or MET amplification.