PMC5836181_01
Magnetic resonance imaging of the brain after gadolinium injection. a FS axial view: enhancement over the midbrain surface and bilateral Sylvian fissure. b FS coronal view: nodular enhanced lesion at the left frontal base.
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F1
MRI demonstrated multiple enhanced lesions (Fig. 1), and CSF cytology examination confirmed the presence of malignant cells (Fig. 2).
ctDNA SMSEQ analysis of CSF. Blue box, expected ERBB2 (HER2) gene counts; black dot, ERBB2 gene counts (HER2 amplification) in the patient's CSF.
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F3
CDKN2A and TP53 genes (Fig. 3; Table 1). Considering the CSF-ctDNA NGS results and recommendations, ado-trastuzumab emtansine was added to the combination regimen of intrathecal trastuzumab and oral lapatinib.