Concomitant Epidermal Growth Factor Receptor Mutation and EML4-ALK Fusion in a Patient with Multifocal Lung Adenocarcinomas Jun Fan, MD Journal of Thoracic.

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Concomitant Epidermal Growth Factor Receptor Mutation and EML4-ALK Fusion in a Patient with Multifocal Lung Adenocarcinomas Jun Fan, MD Journal of Thoracic Oncology Volume 13, Issue 3, Pages e45-e48 (March 2018) DOI: 10.1016/j.jtho.2017.11.130 Copyright © 2018 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 Computed tomography scan before and after treatment. A mass approximately 1.8 × 1.2 cm in the right upper lobe (A) and a small nodule in the right lower lobe adjacent to pleura (B) were seen before treatment. After a right lower lobe wedge resection and 3 months of EGFR tyrosine kinase inhibitor treatment, a slight enlargement (to 2.1 × 1.6 cm) of the mass in the right upper lobe (C) and multiple nodules varying in size in the bilateral lung (D) presented. After 2 months of crizotinib therapy targeting ALK rearrangement, the lesions in the two lungs had almost disappeared (E and F). Journal of Thoracic Oncology 2018 13, e45-e48DOI: (10.1016/j.jtho.2017.11.130) Copyright © 2018 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 Microscopic and molecular characteristic of multifocal adenocarcinomas. (A) Three spatially separated regions (a, b, and c) occurred in one slide of the adenocarcinoma lesion (hematoxylin and eosin [HE]; original magnification, ×1.25). (B) Regions a and c showed a solid growth pattern (HE; original magnification, ×100), whereas area b presented with a papillary pattern (HE; original magnification, ×100) (C). Anaplastic lymphoma kinase protein was positively expressed in the solid regions a and c (immunohistochemistry; original magnification, ×100) (D) but not in papillary area b (immunohistochemistry; original magnification, ×100) (E). The break-apart fluorescence (FISH) in situ hybridization assay verified ALK receptor tyrosine kinase gene (ALK) rearrangement in solid regions a and c (FISH; original magnification, ×1000) (F) but not in area b (FISH; original magnification, ×1000) (G). However, no mutations of EGFR were not found in solid regions a and c (H), but a deletion of EGFR exon 19 presented in papillary area b (I) by the amplification refractory mutation system–polymerase chain reaction method. Journal of Thoracic Oncology 2018 13, e45-e48DOI: (10.1016/j.jtho.2017.11.130) Copyright © 2018 International Association for the Study of Lung Cancer Terms and Conditions