PMC10318538_01
Imaging findings of case 1. The computed tomography scan of before and after neoadjuvant alectinib. CT, computed tomography.
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In contrast-enhanced computerized tomography (CT) of the chest, a mass of approximately 53 mm in length was found in the left lower lobe, along with an isolated nodule of 6 mm in the same lung lobe ( Figure 1 ). A CT scan was performed to assess the efficacy of neoadjuvant therapy. A partial response was achieved after neoadjuvant therapy, with 66% shrinkage of the mass (18 mmx15 mm), and the solitary nodule in the left lower lobe disappeared ( Figure 1 ).
Pathologic findings of case 1. (A), Percutaneous lung biopsy of the mass before treatment showed pulmonary adenocarcinoma (Hematoxylin-eosin, HE, 100x ); (B), Tumor cells positive by immunohistochemistry for TTF-1 (100x); (C), Tumor cells positive by immunohistochemistry for Napsin-A (100x); (D), Immunohistochemical testing results (D5F3 assay) confirmed strong positivity of ALK (100x ); (E, F), Postoperative pathology examination showed pathological complete response to neoadjuvant alectinib with no residual viable tumor cell. (HE, 100x ).
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The patient had a CT-guided percutaneous lung biopsy and was diagnosed with pulmonary adenocarcinoma ( Figure 2 ). Immunohistochemical testing results (D5F3 assay, Ventana-Roche Diagnostics, Mannheim, Germany) confirmed anaplastic lymphoma kinase (ALK) positivity ( Figure 2 ). IASLC multidisciplinary recommendations for pathologic assessment of lung cancer resection specimens after neoadjuvant therapy, the components of the primary tumor bed are 0% viable tumor, 10% necrosis, and 90% stroma, consistent with pCR ( Figure 2 ). In addition, no metastatic carcinoma was seen in any lymph nodes resected in stations 4L, 5L, 7, 8, 10L, and 11L (a total of 9 lymph nodes).
PMC10318538_02
Imaging findings of case 2. The bronchoscopic findings and computed tomography scan of baseline and after neoadjuvant alectinib. CT, computed tomography.
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An enhanced computed tomography scan revealed a large mass with a diameter of 58 mm and an additional nodule (5 mm) on the right interlobar pleural in the same lobe ( Figure 3 ). Bronchoscopy showed a neoplasm obstructed the medial segment of the right middle lobe bronchus ( Figure 3 ). After 32 weeks of alectinib treatment, a re-evaluation showed a 70% reduction of the tumor in the right middle lobe, with no pleural nodules detected ( Figure 3 ).
Pathologic findings of case 2. (A), Bronchoscopic biopsy of the mass before treatment showed pulmonary adenocarcinoma (Hematoxylin-eosin, HE, 100x ); (B), Tumor cells positive by immunohistochemistry for TTF-1 (100x); (C), Tumor cells positive by immunohistochemistry for Napsin-A (100x); (D), Immunohistochemical testing results (D5F3 assay) confirmed strong positivity of ALK (100x); (E, F), Postoperative pathology examination showed pathological complete response to neoadjuvant alectinib with no residual viable tumor cell. (HE, 100x).
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Tumor cells were positive by immunohistochemistry for TTF-1 and Napsin-A ( Figure 4 ). Postoperative histologic examination demonstrated a complete pathological response ( Figure 4 ).