Detection of ALK rearrangement in an octogenarian patient with pleomorphic carcinoma of the lung

Abstract

We herein present a rare case of ALK-positive pulmonary pleomorphic carcinoma in an octogenarian patient. A computed tomography scan of the thorax indicated a pulmonary nodule in the right upper lobe of an asymptomatic 87-year-old female. The surgical resection revealed that the disease was pleomorphic carcinoma with pathological T2aN0M0, stage IB. EML4-ALK was evaluated using immunohistochemistry and fluorescence in situ hybridization, and EGFR mutations were analyzed using the Cycleave method. While there were no EGFR mutations detected, she was positive for the ALK rearrangement. This is the first report of ALK rearrangement in an octogenarian patient with pleomorphic carcinoma of the lung.

Pulmonary Sarcomatoid Carcinoma with ALK Rearrangement: Frequency, Clinical-Pathologic Characteristics, and Response to ALK Inhibitor

“…Both previous reports and our present study revealed that ALK rearrangement is more likely to be detected in PSCs with adenocarcinoma components of younger never-smoked patients [12], [13], [14]. Another intriguing observation we found involves two patients with carcinosarcoma harboring ALK rearrangement.…”

“…Previously, almost all of the studies using a small sample size have reported that no ALK rearrangement occurred in PSC [10], [11]. Recently, a few cases of ALK rearrangement-positive PSC have been reported in Japan [12], [13], [14]. In our large sample study, the incidence rate of ALK rearrangement in PSC was 3.5%, which is similar to the frequency in typical NSCLC.…”

“…Previously, several small sample size studies have reported no anaplastic lymphoma kinase (ALK) rearrangement in PSC, yet recently, some isolated case reports have shown patients of PSC harboring ALK rearrangement [12], [13], [14]. Because the frequency is controversial, the value of routine detection of ALK rearrangement and the clinical benefit from anti-ALK treatment in PSC remain unknown.…”

Anaplastic lymphoma kinase (ALK)-rearranged pulmonary pleomorphic carcinoma successfully treated with crizotinib

“…Other studies describe three patients aged 50, 69, and 87 years with PPC with ALK rearrangements. 12 – 14 These findings suggest that ALK-positive PPC patients may be older than patients with ALK-positive lung adenocarinoma. 10 Moreover, it is notable that the epithelial components of our patients and those of the three aforementioned patients were all adenocarcinomas, consistent with the findings of Chen et al 15 that 4 of 5 ALK-positive patients with PSC had adenocarcinomas with epithelial components.…”

‘Inflammatory myofibroblastic tumour’‐like dedifferentiation of anaplastic lymphoma kinase‐rearranged lung adenocarcinoma

“…5 Among more poorly differentiated or sarcomatoid carcinomas, ALK rearrangement is rare. 6,7 However, two cases of ALK-rearranged pleomorphic lung carcinoma 8,9 and two cases of ALK-positive carcinoma with a sarcomatoid component have been reported, 5 and two isolated reports have described patients with ALK-rearranged lung adenocarcinoma who subsequently developed a dedifferentiated sarcomatoid component that also harboured an ALK fusion. 10,11 Activation of ALK most commonly occurs through gene fusion events, many of which are unique to different tumour types.…”