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BMC Pulm Med
2013 Apr 25;13:25. doi: 10.1186/1471-2466-13-25.
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A case of synchronous bilateral lung cancers: EML4-ALK positive adenocarcinoma in the right lung and adenocarcinoma in situ (the former bronchioloalveolar carcinoma) in the left lung.
Matsuda I
,
Takeuchi K
,
Mizuguchi S
,
Kaji M
,
Ueda K
,
Teramura K
,
Hirota S
.
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BACKGROUND: Recently it has been revealed that lung adenocarcinomas with distinct gene mutations or fusions are associated with particular histopathological entities. For example, epidermal growth factor receptor (EGFR) gene mutations are often associated with well differentiated adenocarcinoma of the lung with bronchioloalveolar pattern. On the other hand, echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) fusion gene in a subset of lung adenocarcinoma is related to mucinous cribriform histology.
CASE PRESENTATION: Reported herein is a case of synchronous EML4-ALK positive lung adenocarcinoma and adenocarcinoma in situ in the bilateral lungs of a 55-year-old Japanese woman. The woman had EML4-ALK positive lung adenocarcinoma in the right lower lung while adenocarcinoma in situ in the left upper lung, which was EML4-ALK negative.
CONCLUSION: To our knowledge, this is the first report of synchronous, bilateral lung adenocarcinomas composed of EML4-ALK positive and negative ones.
Figure 1. Preoperative chest CT image. It reveals a 38×12 mm stellate-shaped mass in the right lower lobe (a) and a 15×10 mm ground-glass opacity shadow in the left upper lobe of the lung (b).
Figure 2. Histological and FISH analysis. Microscopic and immunohistochemical examination of the right lung cancer reveals a mucinous cribriform pattern (a) (HE stain, ×200), which is positive for ALK (b) (immunohistochemical staining, ×200). The right lung cancer also contains a bronchioloalveolar pattern (c) (HE stain, ×200), which is again positive for ALK (d) (immunohistochemical staining, ×200). On the other hand, the left lung cancer is composed singly of a bronchioloalveolar pattern (e) (HE stain, ×200), which is negative for ALK (f) (immunohistochemical staining, ×200). FISH analyses revealed EML4-ALK fusion gene in the tumor of the right lung (g-j). FISH signals in a single tumor cell are shown. (g)-(i) EML4-ALK fusion FISH. The signals for ALK gene (g) and EML4 gene (h) are indicated by green and red dots, respectively. The signal for EML4-ALK fusion gene is indicated by a white arrow (i). (j) ALK split FISH. The signals for 5′ and 3′ probe for ALK gene are indicated by green and red dots, respectively. Split of the green and the red dots is consistent with the presence of EML4-ALK fusion gene.
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