ROS1‑rearranged high‑PD‑L1‑expressing lung adenocarcinoma manifesting as mediastinal tumor: A case report
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- Published online on: October 25, 2018 https://doi.org/10.3892/ol.2018.9622
- Pages: 488-491
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Abstract
ROS proto‑oncogene 1 receptor tyrosine kinase (ROS1)‑rearranged lung cancer is rare and comprises only 1% of lung adenocarcinoma cases. It has recently been reported to have good response to crizotinib, a tyrosine kinase inhibitor of anaplastic lymphoma kinase. Driver oncogene mutations with approved therapies seldom coexist with a high expression of Programmed death‑ligand 1 (PD‑L1). The present case report describes a rare case of ROS1 rearrangement with high‑PD‑L1‑expressing occult lung adenocarcinoma. A 32‑year‑old woman presented with chest pain and a prolonged cough. Chest computed tomography (CT) revealed a 57x36‑mm tumor in the mediastinum, with no tumors detected in other regions. Positron emission tomography (PET)‑CT showed a strong fluorodeoxyglucose accumulation in the tumor (SUVmax 13.2). Mediastinal tumor resection was completely resected using a video‑assisted thoracic surgery approach. Pathological examination showed the tumor cells were positive for thyroid transcription factor 1, Napsin‑A, ROS1, and PD‑L1 (tumor proportion score >99%). ROS1 rearrangement was confirmed by fluorescence in situ hybridization. The mediastinal tumor was diagnosed as mediastinal lymph node metastasis of ROS1‑rearranged PD‑L1 high‑expression undifferentiated lung adenocarcinoma (pathological stage 3, TxN2M0). Two months after the operation, the CT scan showed multiple mediastinum lymph nodes metastases with rapid tumor growth. The patient achieved a complete response after three cycles of S‑1 plus cisplatin with concurrent radiotherapy 60 Gy/30 Fr.
