PMC8055486_01
Baseline thoracic computed tomography (CT) scan demonstrating a 32 x 30 mm pulmonary mass in the posterior left inferior lobe and pleural metastases and pleural effusion in (A) and (B). The last thoracic CT scan image evaluation in (C) and (D) demonstrating stable disease with TKI gefitinib. Bone scintigraphy demonstrates metastatic bone disease in the spine and pelvis bone at baseline (E) and at the latest evaluation (F).
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F1
After the etiologic workup, a stage IV (cT2aN2M1c) lung adenocarcinoma was diagnosed with multiple bone, pulmonary, and pleural metastasis (Fig. 1). After 16 months, she maintains gefitinib with stable disease (Fig. 1), controlled symptoms, and an improvement in PS to ECOG 1.
Histology of the primary tumour: (A) Adenocarcinoma. Irregularly shaped glands are lined by cells with abundant cytoplasm and pleomorphic nuclei (HE, 200x). (B) Diffuse TTF1 expression. (C) Focal PD-L1 expression (22C3). NGS results from the patient: (D) Presence of the exon 21 p.(Leu858Arg) EGFR mutation. (E) Presence of ALK rearrangement, along with positive control genes (MYC, HMBS, PRPI, TBP and ITGB7).
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F2
NGS test revealed the exon 21 p.(Leu858Arg) EGFR mutation and an ALK rearrangement (Fig. 2).