26 January 2018 : Case report
Hemorrhagic Brain Metastases in a Patient with Anaplastic Lymphoma Kinase (ALK)-Rearranged Invasive Mucinous Adenocarcinoma of the Lung
Rare diseaseMingxia Shi1ABCDEF*, Hongzhi Xu1B, Angela DiPoto Brahmbhatt2BD, Eduardo Gonzalez-Toledo3D, Maria-Magdalena Georgescu1BCDEF
Am J Case Rep 2018; 19:99-104
BACKGROUND: Invasive mucinous adenocarcinoma (IMA) is a rare variant of adenocarcinoma of the lung. It frequently shows KRAS mutations, while ALK rearrangement is exceedingly rare. We present a case of ALK-rearranged IMA of the lung presenting with an unusual pattern of brain metastases, radiologically mimicking a cavernous angioma.
CASE REPORT: A 44-year-old non-smoker female was first diagnosed with lung right lower lobe IMA with ALK rearrangement. Five years after surgery followed by chemotherapy, she developed a sudden onset headache. Brain imaging revealed a hemorrhagic left frontal mass, suspicious for a cavernous angioma. However, the pathology of the resected lesion showed an ALK-rearranged brain metastasis from the IMA of the lung. Interestingly, the metastases showed perivascular tumor infiltrates, accompanied by focal mural invasion, vascular disruption, and hemorrhage.
CONCLUSIONS: To our knowledge, this is the first reported case of brain metastasis from an ALK-rearranged IMA of the lung. Further investigation of the clinical and pathological characteristics of the ALK-rearranged IMA, including awareness of the possibility for development of brain metastases with tumor-associated vasculopathy and hemorrhage, is warranted.
Keywords: Adenocarcinoma, Mucinous, Gene Rearrangement, Lung Neoplasms, Neoplasm Metastasis
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