PMC8348148_01
Summary of chest computed tomography findings. At initial diagnosis (A, B), at 15 months after administration of alectinib (C, D) and after 7 months of combination therapy with alectinib and osimertinib (E, F). A 32-mm solid mass in the LLL (A) and a 21-mm mixed ground glass nodule in the RLL (B) were detected at initial diagnosis. After treatment with alectinib, the LLL mass was shrunk (C), the RLL mass was enlarged, and the pleural effusion was increased (D). Combination therapy with alectinib and osimertinib resulted in shrinkage of the RLL mass and decrease in the right pleural effusion (F). LLL, left lower lobe; RLL, right lower lobe.
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Chest computed tomography (CT) revealed mediastinal lymphadenopathy, right slight pleural effusion and four opacities, including a 32-mm solid mass in the left lower lobe (LLL), a 21-mm mixed ground glass nodule (GGN) in the right lower lobe (RLL), a 18-mm GGN in the left upper lobe (LUL) and a 9-mm GGN in the right upper lobe (RUL) (Fig. 1A and B). The patient remained in remission under treatment with alectinib for 15 months; nevertheless, the level of serum CEA was elevated, followed by the enlargement of the RLL mass and the increase in right pleural effusion (Fig. 1C and D). This combination therapy has been continued for >15 months, with good partial response for both lung cancers and absence of any adverse effects (Fig. 1E and F).
Pathological examinations of hematoxyline and eosin staining (A, C) and immunohistochemical detection of ALK fusion oncoprotein (B, D). (A, B) The mass in the left lower lobe showed poorly differentiated adenocarcinoma stained for ALK. (C, D) The cell block sample from the right pleural effusion with adenocarcinoma showed non-mucinous adenocarcinoma. The cells showed no staining for ALK. Scale bars: 50 mum in inserts. ALK, anaplastic lymphoma kinase.
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Pathological examination revealed poorly differentiated adenocarcinoma (Fig. 2A). Immunohistochemistry and fluorescence in situ hybridization identified ALK rearrangement without EGFR mutation (Fig. 2B). The cell block specimen of the right pleural effusion showed adenocarcinoma harboring an EGFR exon 19 deletion without ALK rearrangement (Fig. 2C and D).