PMC8079359_01
(A) NGS confirmed ALK fusion (EML4 exon 13-ALK exon 20, variant allele frequency was 4192); (B) EGFR 18 exon (c.2156G>C:55241708, p. G719A, abundance 74.8%); (C) EGFR exon 19 (c2239T>G:55242469, pL747V, abundance 70.05%).
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IIB lung adenocarcinoma. Immunohistochemistry (IHC) showed ALK-D5F3(-), while NGS-based analysis of surgical specimens revealed an ALK fusion (EML4 exon 13-ALK exon 20, variant allele frequency was 4192, Figure 1A), EGFR 18 exon (c.2156G>C:55241708, p. G719A, abundance 74.8%, Figure 1A) and EGFR exon 19 (c2239T>G:55242469, pL747V, abundance 70.05%, Figure 1A).
(A and B) Thoracic CT scan detected a subpleural soft tissue mass in the right upper lung (red arrows); (C and D) after 4 weeks of treatment with afatinib, a thoracic CT scan showed a diminished subpleural tumor in the right upper lung.
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A thoracic CT scan detected a subpleural soft tissue mass of the RUL (Figure 2A and B), and brain MRI detected abnormal enhancement in the brain and leptomeningeal linear enhancement in the cerebellar hemisphere (Figure 3A-C). After 4 weeks, the patient's dizziness and neck pain were significantly improved, a thoracic CT scan showed diminished subpleural tumor of the right upper lung (Figure 2C and D), and brain MRI showed that the abnormal enhancement in the brain and leptomeningeal linear enhancement in the cerebellar hemisphere had disappeared (Figure 3D-F).
(A) Brain MRI detected abnormal enhancement in the brain (red arrows) and (B and C) leptomeningeal linear enhancement (red arrows) in the cerebellar hemisphere; (D) brain MRI showed that the abnormal enhancement in the brain and (E and F) the leptomeningeal linear enhancement in the cerebellar hemisphere had disappeared.
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A thoracic CT scan detected a subpleural soft tissue mass of the RUL (Figure 2A and B), and brain MRI detected abnormal enhancement in the brain and leptomeningeal linear enhancement in the cerebellar hemisphere (Figure 3A-C). After 4 weeks, the patient's dizziness and neck pain were significantly improved, a thoracic CT scan showed diminished subpleural tumor of the right upper lung (Figure 2C and D), and brain MRI showed that the abnormal enhancement in the brain and leptomeningeal linear enhancement in the cerebellar hemisphere had disappeared (Figure 3D-F).
Lumbar puncture indicated positive cytology of cerebrospinal fluid (at high magnification 10 * 40).
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Lumbar puncture indicated positive cytology of cerebrospinal fluid (CSF) (Figure 4).