PMC9127844_01
Thorax CT scan (lung window) showing 
SLC12A2-ROS1
 advanced lung adenocarcinoma in a young never-smoker female. (a, b, and c): baseline imaging showing consolidative (red arrow) and ground-glass (green arrowhead) opacities consistent with neoplastic infiltration (date: 22 February 2020). (d, e and f): dramatic partial response 28 days after starting crizotinib (date: 28 March 2020).
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Six years later, she presented with bilateral pulmonary involvement at a chest CT scan (Figure 1(a)-(c)) and a transthoracic needle biopsy histologically confirmed recurrent LAC displaying acinar and micropapillary patterns, with positive immunostaining for TTF-1 and Napsin (Figure 2(a)-(d)). She experienced a fast symptomatic relief and the chest CT scan performed 4 weeks later showed marked tumor regression (Figure 1(d)-(f)).
(a) Left lung transthoracic biopsy (HE 60x): adenocarcinoma infiltrating pulmonary tissue and exhibiting acinar and micropapillary architectural patterns. (b) Left lung transthoracic biopsy (HE 200x): high power view of lung adenocarcinoma showing acinar (upper left) and micropapillae (lower right). (c) Immunohistochemistry showing positivity for TTF1. (d) Immunohistochemistry disclosing positivity for Napsin.
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Six years later, she presented with bilateral pulmonary involvement at a chest CT scan (Figure 1(a)-(c)) and a transthoracic needle biopsy histologically confirmed recurrent LAC displaying acinar and micropapillary patterns, with positive immunostaining for TTF-1 and Napsin (Figure 2(a)-(d)).
Illustration of the unique SLC12A2-ROS1 fusion with specific breakpoints, showing ROS1 kinase domain preservation (illustration created with aid of Microsoft PowerPoint).
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The fusion breakpoints based on GRCh37/hg19 are chr5:127492189-127492398 (intron 15) of SLC12A2 gene and chr6:117641629-117642055 (intron 35) of ROS1 gene, resulting in a fusion 5'-SLC12A2(ex1-15 NM_001046)-ROS1(ex36-43 NM_002944), with 96 supporting read pairs (Figure 3).
Timeline summarizing the patient's treatment.
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A timeline summarizing the patient's entire treatment is shown in Figure 4.