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Histological findings. (A) Hematoxylin and eosin (HE) staining. (B-D) IHC results of TTF-1, CK7 and Napsin A.
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A (+), TTF-1 (+) and Ki67 (15%) (Figure 1A-D) revealed poorly differentiated lung adenocarcinoma. According to the TNM classification of the 8th edition of the Union of International Cancer Control (UICC), the patient was diagnosed with clinical stage IV (T4N3M1). 
Analysis of ALK fusion. (A) DNA-seq of FBXO11 (intergenic)-ALK (Exon 20-29) fusion and (B) RNA-seq of EML4 (Exon 1-13)-ALK (Exon 20-29) fusion. (C) FISH revealed ALK gene fracture. (D) Derivation of ALK fusion process (inversion + deletion).
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ALK(+) (Figure 2C) respectively. Studies have shown that crizotinib significantly improved progression-free survival (PFS) and overall survival (OS) in ALK-positive patients compared with chemotherapy, which is recommended for first-line treatment in the NCCN guidelines. After full informed consent from the patient and his family, the patient was treated with crizotinib orally at a dose of 250mg daily on September 4, 2021, his cough was significantly relieved after a week and achieved continuous PR during the follow-up (Figure 3A-D).
Representative clinical images before and after crizotinib treatment. (A-D) Comparison of primary lesions on baseline and every 8 weeks.
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ALK(+) (Figure 2C) respectively. Studies have shown that crizotinib significantly improved progression-free survival (PFS) and overall survival (OS) in ALK-positive patients compared with chemotherapy, which is recommended for first-line treatment in the NCCN guidelines. After full informed consent from the patient and his family, the patient was treated with crizotinib orally at a dose of 250mg daily on September 4, 2021, his cough was significantly relieved after a week and achieved continuous PR during the follow-up (Figure 3A-D).