PMC8767047_01
The clinical treatment history of the patient. Chest computed tomography (CT) and histological findings were presented. HE staining showed lung adenocarcinoma. Immunochemistry results suggested non-reciprocal ALK fusion: ALK-GCA (A19: intragenic) and EML4-ALK (E20: A20) expressed significantly at the protein level.
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Chest computed tomography (CT) scan revealed a lung mass with a diameter of about 5.1 cm in the left lower lobe and 7-10 rib fracture in January 2020 ( Figure 1 ). For further treatment, he received pulmonary lobectomy in March 2020, with a pathologic diagnosis of stage IIIB (pT3N2M0) moderately and poorly differentiated invasive lung adenocarcinoma (acinar type, micropapillary pattern, solid form) ( Figure 1 ). Figure 1 ). Furthermore, we conducted fluorescence in situ hybridization (FISH) and confirmed the positive ALK gene break using commercially available probes (GSP ALK, Anbiping Pharmaceutical Technology Co., Ltd.) ( Figure 2C ).
Next-generation sequencing and FISH results of surgical specimen of the patient. (A) ALK-GCA (A19: intragenic) and EML4-ALK (E20: A20) ALK rearrangement visualized using the Integrative Genomics Viewer (IGV). (B) Diagram depicting the non-reciprocal ALK fusion: ALK-GCA (A19: intragenic) and EML4-ALK (E20: A20). (C) ALK gene rearrangement positive signal (one green and one red, by white arrow) (*1,000).
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Figure 1 ). Furthermore, we conducted fluorescence in situ hybridization (FISH) and confirmed the positive ALK gene break using commercially available probes (GSP ALK, Anbiping Pharmaceutical Technology Co., Ltd.) ( Figure 2C ). ALK fusion: ALK-GCA (A19: intragenic) (abundance: 17.18%) and EML4-ALK (E20: A20) (abundance: 14.47%) ( Figure 2A ). After a multidisciplinary discussion, alectinib as adjuvant targeted therapy was administrated for him to reduce the risk of tumor recurrence.