PMC6333155_01
Main lesion with positive positron emission tomography-computed tomography (PET-CT).
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Positron emission tomography-computed tomography (PET-CT) was performed with positive 9SUV grade from the main lesion and 4.5SUV from the station 11 left; there were no other pathological lymph nodes according to the PET-CT (Figures 1-2).
Positron emission tomography-computed tomography with lymph node station number 11 left (arrow).
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Positron emission tomography-computed tomography (PET-CT) was performed with positive 9SUV grade from the main lesion and 4.5SUV from the station 11 left; there were no other pathological lymph nodes according to the PET-CT (Figures 1-2).
Left, computed tomography of the thorax with lymph node station number 11 left; middle, the carina of the left upper and lower lobe; and right, the lymph node 22 left with the convex probe ultrasound.
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Biopsy was performed from the main lesion with CT guidance, and convex probe EBUS was used for additional staging of the mediastinum (Figure 3).
ALK gene rearrangement by FISH in the case of lung adenocarcinoma with positivity in 31% of neoplastic cells. FISH, ZytoLight SPEC ALK dual color, break apart probe (ZytoVision GmbH).. Abbreviation: ALK, anaplastic lymphoma kinase; FISH, fluorescence in situ hybridization.
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Additionally, fluorescence in situ hybridization (FISH) was performed and revealed ALK translocation/fusion (Figure 4).
Positron emission tomography-computed tomography with the disease relapse lesion under the diaphragm 1.2 cm.
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Sixteen months after surgery, a small lesion of 1.2 cm was observed right under the diaphragm and next to the vertebra with PET-CT 6SUV and biopsy was performed (Figure 5).
PD-L1 expression to the relapse site (nodule under the diaphragm).. Notes: (A) Programmed death-ligand 1-positive case with whole membranous staining (intense 1+ and 2+) in 90% of neoplastic cells; (B) hematoxylin/eosin of the same case (undifferentiated lung adenocarcinoma), magnification x100.
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Again, it was NSCLC adenocarcinoma with next generation sequencing negative for any gene mutation and negative ALK translocation/fusion with FISH; however, PD-L1 expression was 90% (Figure 6).
Main tumor PD-L1 expression after surgery.. Notes: (A) Programmed death-ligand 1-negative case without any membranous, whole or partially positive, magnification x100; (B) hematoxylin/eosin of the same case with numerous neoplastic adenocarcinoma cells, magnification x100.
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We performed PD-L1 in the main tumor lesion and the expression was 0% (Figure 7).