A Case of Large-Cell Neuroendocrine Carcinoma Harboring an EML4–ALK Rearrangement with Resistance to the ALK Inhibitor Crizotinib Naoki Omachi, MD, Shigeki.

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A Case of Large-Cell Neuroendocrine Carcinoma Harboring an EML4–ALK Rearrangement with Resistance to the ALK Inhibitor Crizotinib Naoki Omachi, MD, Shigeki Shimizu, MD, PhD, Tomoya Kawaguchi, MD, Kenji Tezuka, MD, Masaki Kanazu, MD, Akihiro Tamiya, MD, Kazuhiro Asami, MD, Kyoichi Okishio, MD, Masanori Kitaichi, MD, Shinji Atagi, MD Journal of Thoracic Oncology Volume 9, Issue 6, Pages e40-e42 (June 2014) DOI: 10.1097/JTO.0000000000000103 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Imaging findings. A, Chest radiograph on admission showing a mass in the left upper field; (B) chest computed tomography scan on admission showing a lung mass in the left upper lobe; (C) enhanced brain MRI scan on admission showing metastasis to the right cerebellar region; (D) subsequent enhanced brain MRI revealing an increase in the size of the right cerebellar lesion. MRI, magnetic resonance imaging. Journal of Thoracic Oncology 2014 9, e40-e42DOI: (10.1097/JTO.0000000000000103) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Histopathological findings of the breast. A, Low-power image of a hematoxylin and eosin–stained section from the breast tumor showing cells organized in solid nests or forming trabeculae with foci of necrosis and rosette-like structures; (B) immunohistochemical analysis of the breast tumor showing strong diffuse synaptophysin positivity; (C) immunohistochemical analysis showing strong diffuse ALK positivity; (D) fluorescence in situ hybridization analysis of the ALK locus using a break-apart probe strategy. Approximately 58% of breast tumor cells showed rearrangement at the ALK locus, as demonstrated by split red/green signals (arrows). ALK, anaplastic lymphoma kinase. Journal of Thoracic Oncology 2014 9, e40-e42DOI: (10.1097/JTO.0000000000000103) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions