24518095 Visualization

A 44 Age - year Age - old Age Chinese Personal_background man Sex with a 7 History pack History - year History smoking Activity history History was referred Clinical_event to Shanghai Nonbiological_location Pulmonary Nonbiological_location Hospital Nonbiological_location in February Date 2013 Date for a left Biological_structure upper Biological_structure lobe Biological_structure lung Biological_structure mass Sign_symptom with multiple Detailed_description bilateral Detailed_description intrapulmonary Biological_structure metastases Sign_symptom , left Detailed_description pleural Disease_disorder effusion Disease_disorder , and 2R/4R/10L/11L Lab_value lymphadenopathy Disease_disorder .
Pleural Biological_structure fluid Biological_structure cytology Diagnostic_procedure revealed adenocarcinoma Disease_disorder and Scorpion Diagnostic_procedure Amplification Diagnostic_procedure Refractory Diagnostic_procedure Mutation Diagnostic_procedure system Diagnostic_procedure ( AmoyDx Detailed_description Co., Detailed_description Xiamen, Detailed_description China Detailed_description ).
showed no detectable epidermal Sign_symptom growth Sign_symptom factor Sign_symptom receptor Sign_symptom mutation Sign_symptom .
He commenced chemotherapy Medication with gemcitabine Medication and cisplatin Medication .
However, after a single cycle, his symptoms Sign_symptom worsened and imaging confirmed progressive Detailed_description disease Disease_disorder .
A second Clinical_event opinion Clinical_event was Clinical_event requested Clinical_event from the University Nonbiological_location of Nonbiological_location Colorado Nonbiological_location and a computed Detailed_description tomography Detailed_description – guided Detailed_description biopsy Diagnostic_procedure of the left Biological_structure upper Biological_structure lobe Biological_structure lesion Sign_symptom was performed to permit additional molecular testing.
In the interim, the patient commenced pemetrexed Medication and nedaplatin Medication .
Unfortunately, after two cycles his shortness Sign_symptom of Sign_symptom breath Sign_symptom worsened, with evidence of further Sign_symptom progression Sign_symptom on his scans Diagnostic_procedure (Fig.1A).
Molecular testing on his repeat biopsy Diagnostic_procedure specimen revealed no mutations Sign_symptom by SNaPshot Detailed_description multiplex Detailed_description PCR Diagnostic_procedure testing Diagnostic_procedure (Life Technologies, Carlsbad, CA).
However, although technically negative, the ALK Detailed_description break Detailed_description - apart Detailed_description FISH Diagnostic_procedure test Diagnostic_procedure showed an atypical Lab_value negative Lab_value pattern Lab_value .
Specifically, 68% Lab_value of Lab_value cells Lab_value demonstrated Lab_value single Lab_value copies Lab_value of Lab_value the Lab_value 5′ Lab_value ALK Lab_value signal Lab_value and numerous Lab_value cells Lab_value with Lab_value doublets Lab_value of Lab_value the Lab_value 5′ Lab_value ALK Lab_value signal Lab_value combined Lab_value with Lab_value one Lab_value 3′ Lab_value ALK Lab_value signal Lab_value (Fig.2A).
Subsequently, confirmatory diagnostic Diagnostic_procedure assays Diagnostic_procedure demonstrated ALK Lab_value protein Lab_value expression Lab_value by IHC Diagnostic_procedure using the D5F3 Detailed_description antibody Detailed_description ( Cell Detailed_description Signaling Detailed_description Technology Detailed_description Inc., Detailed_description Danvers, Detailed_description MA Detailed_description ; H score = 150; Fig.2B) and the presence Lab_value of Lab_value an Lab_value echinoderm Lab_value microtubule Lab_value - associated Lab_value protein Lab_value - like Lab_value 4 Lab_value (EML4)-ALK transcript Lab_value (E13; A20) by RT Diagnostic_procedure - PCR Diagnostic_procedure (Fig.2C).
The patient then received crizotinib Medication ( 250 Dosage mg Dosage twice Dosage daily Dosage ) as third-line therapy in May Date 2013 Date with an impressive symptomatic Sign_symptom improvement Sign_symptom and CT response after Date 1 Date month Date of therapy (Fig.1B).
He remains on treatment with crizotinib Medication with no evidence of progression Sign_symptom as of September Date 2013 Date .