Takeda Masahide, Sato Kazuhiro, Sakamoto Sho, Suzuki Maya, Izumiya Yuka, Kumagai Naho, Sudo Kazuhisa, Okuda Yuji, Asano Mariko, Sano Masaaki, Omori Yasufumi, Nakayama Katsutoshi
Department of Respiratory Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
Department of Molecular and Tumor Pathology, Akita University Graduate School of Medicine, Akita, Japan.
J Med Case Rep. 2019 Apr 29;13(1):118. doi: 10.1186/s13256-019-2054-3.
Anaplastic lymphoma kinase-positive lung cancer is a form of lung cancer that accounts for approximately 5% of non-small cell lung cancers. Recently, anaplastic lymphoma kinase inhibitors have been used for treatment of anaplastic lymphoma kinase-positive lung cancer, and their high clinical effect has also been demonstrated in cases of advanced stage lung cancer. Alectinib is an anaplastic lymphoma kinase inhibitor that it is recognized as a standard drug for primary therapy because of its superiority to crizotinib.
A 37-year-old Japanese man was admitted to our hospital due to multiple brain metastases. An autopsy report revealed that the cause of death was anaplastic lymphoma kinase-positive lung cancer, exacerbated in a short period despite treatment with alectinib. Necropsy revealed anaplastic lymphoma kinase-positive adenosquamous carcinoma of the lung, suggesting that it was involved in the prognosis of this patient. Based on the autopsy results, we reviewed the pathological tissue from transbronchial lung biopsy at the time of clinical diagnosis. The tissue specimen for clinical diagnosis in this case was a papillary adenocarcinoma. However, when this tissue was immunostained, thyroid transcription factor 1-negative and cytokeratin 5/6-positive parts were recognized. This result indicates that we could diagnose this patient as having had adenosquamous carcinoma of the lung.
In cases of anaplastic lymphoma kinase-positive lung cancer poorly responsive to anaplastic lymphoma kinase inhibitors, re-examination of the tissue should be considered because there is a possibility of anaplastic lymphoma kinase-positive adenosquamous carcinoma.
间变性淋巴瘤激酶阳性肺癌是肺癌的一种形式，约占非小细胞肺癌的5%。最近，间变性淋巴瘤激酶抑制剂已被用于治疗间变性淋巴瘤激酶阳性肺癌，其在晚期肺癌病例中也显示出较高的临床疗效。阿来替尼是一种间变性淋巴瘤激酶抑制剂，因其优于克唑替尼而被认为是一线治疗的标准药物。
一名37岁的日本男性因多发脑转移入院。尸检报告显示，死因是间变性淋巴瘤激酶阳性肺癌，尽管接受了阿来替尼治疗，但在短时间内病情仍加重。尸检发现肺部有间变性淋巴瘤激酶阳性腺鳞癌，提示其与该患者的预后有关。根据尸检结果，我们回顾了临床诊断时经支气管肺活检的病理组织。该病例临床诊断的组织标本为乳头状腺癌。然而，对该组织进行免疫染色时，发现甲状腺转录因子1阴性和细胞角蛋白5/6阳性部分。这一结果表明，我们可以诊断该患者患有肺腺鳞癌。
对于对间变性淋巴瘤激酶抑制剂反应不佳的间变性淋巴瘤激酶阳性肺癌病例，应考虑重新检查组织，因为有可能是间变性淋巴瘤激酶阳性腺鳞癌。
