PMC4913993_01
Images of PET-CT for the patient.. Notes: (A) Whole-body FDG fusion PET-CT showed numerous masses in the body. (B and C) PET-CT showed bilateral breast masses.. Abbreviations: FDG, fluorodeoxyglucose; PET-CT, positron emission tomography-computed tomography.
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Positron emission tomography-computed tomography revealed enlarged lymph nodes in the pulmonary hilum and mediastinum and multiple masses in the brain, bilateral lungs, breasts, adrenal glands, liver, body of the T6 vertebra, and spinal marrow of the C6 vertebra (Figure 1).
Images of hematoxylin-eosin staining and immunohistochemistry of breast masses.. Notes: (A) Hematoxylin-eosin staining of the breast masses showed a poorly differentiated adenocarcinoma. (B) Immunohistochemistry of tumor cells was negative for Napsin A. Immunostaining revealed positivity for tumor for (C) TTF-1 and (D) ALK. A and D (magnification, 100x), B and C (magnification, 200x).
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Ultrasound-guided needle biopsy of the bilateral breast lesions was performed, and a poorly differentiated adenocarcinoma was diagnosed by pathology (Figure 2A). Immunohistochemistry results were negative for ER, PR, Her-2, and Napsin A (Figure 2B), and positive for TTF-1 (Figure 2C), CA-153, and Ki-67 (index 20%). Immunohistochemical examination for ALK was also strongly positive (Figure 2D).
CT scan and MRI before and after 3 months treatment with crizotinib.. Notes: (A-D) CT scan and MRI showed masses in the lungs, lymph nodes in the mediastinum, liver, and brain before treatment with crizotinib. (E-H) CT and MRI showed a significant response after 3 months treatment with crizotinib.. Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.
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Surprisingly, partial response was observed after 3 months of treatment with crizotinib (Figure 3).