目的探讨系统性ALK阴性间变性大细胞淋巴瘤(anaplastic large cell lymphoma,ALCL)的临床病理特点、分子特征、治疗和预后。方法回顾性分析18例系统性ALK^(-)ALCL的临床病理特征、免疫表型特点,行HE、免疫组化染色、FISH和NGS检测,并复...目的探讨系统性ALK阴性间变性大细胞淋巴瘤(anaplastic large cell lymphoma,ALCL)的临床病理特点、分子特征、治疗和预后。方法回顾性分析18例系统性ALK^(-)ALCL的临床病理特征、免疫表型特点,行HE、免疫组化染色、FISH和NGS检测,并复习相关文献。结果系统性ALK^(-)ALCL好发于老年男性,常位于进展期,以淋巴结病变为主,结外原发部位包括原发胰腺、原发胸椎;形态学显示17例呈普通型,1例呈“霍奇金样”型。免疫表型:肿瘤细胞中CD30均弥漫强阳性(>75%),CD2(16/17)、CD3(13/18)、CD5(4/18)、CD7(8/18)、CD4(14/18)、TIA-1(16/18)、CD8(2/16)、GATA-3(10/12)、EMA(3/5)、MUM1(12/12)、CD43(6/6)和CD56(2/8)不同程度阳性,Ki67增殖指数30%~90%,PD-L1(22C3)(TPS=0~100%),ALK、CD15、CD79α和CD20均阴性;FISH检测:5例TP63缺失,2例DUSP22缺失。NGS检测:16例发生基因突变,基因突变频率0~11个,平均4.2个基因突变;伴TP63重排的ALK^(-)ALCL更易发生于女性,多发于淋巴结,临床分期晚,易伴p53基因异常。结论伴TP63重排的系统性ALK^(-)ALCL与诸多不良因素相关,临床过程多呈侵袭性,预后不佳。展开更多
The genomic fusions of the anaplastic lymphoma kinase(ALK)gene have been widely recognized as effective therapeutic targets for non-small cell lung carcinoma(NSCLC).The Second Xiangya Hospital of Central South Univers...The genomic fusions of the anaplastic lymphoma kinase(ALK)gene have been widely recognized as effective therapeutic targets for non-small cell lung carcinoma(NSCLC).The Second Xiangya Hospital of Central South University has treated 2 NSCLC patients with 2 distinct novel ALK gene fusions.Case 1 was a 55-year-old male with a solid nodule located in the right hilar lobe on enhanced CT scan.Case 2 was a 47-year-old female with enhanced CT showing involvement of the left upper lobe of lung.Histopathological examination of tumor tissues confirmed lung adenocarcinoma in both cases.Immunohistochemical(IHC)staining demonstrated positivity for thyroid transcription factor 1(TTF-1)and ALK-D5F3 in tumor cells,while negativity for P40.The next-generation sequencing(NGS)tests identified a PNPT1-ALK(Exon22:Exon20)fusion variant in case 1 and a TCEAL2-ALK(Exon3:Exon19)fusion variant in case 2.The TCEAL2-ALK fusion was further confirmed by amplification refractory mutation system(ARMS)-PCR at the mRNA level.Both patients were treated with oral alectinib at a dosage of 600 mg twice daily.The tumors in both patients were significantly decreased after alectinib treatment,achieving partial response.At the time of submission,there was an absence of disease progression and the progression-free survival(PFS)had surpassed 1 year.It offered compelling evidences that the individuals with NSCLC and harboring either a PNPT1-ALK(Exon22:Exon20)fusion or a TCEAL2-ALK(Exon3:Exon19)fusion,experience favorable therapeutic outcomes through the administration of alectinib.This study expands the known ALK fusion variants database and supports the precision treatment of NSCLC using ALK tyrosine kinase inhibitors(TKIs).展开更多
文摘间变淋巴瘤激酶(anaplastic lymphoma kinase,ALK)融合的肺腺癌患者经ALK-酪氨酸激酶抑制剂(ALK-tyrosine kinase inhibitor,ALK-TKI)治疗后可能会产生耐药,其耐药机制尚未完全明确。遵义医科大学附属医院2021年9月收治1例ALK融合的肺腺癌患者,经ALK-TKI治疗后出现耐药,疾病进展后再次活体组织检查(以下简称“活检”),病理类型转化为小细胞肺癌。该患者为54岁女性,首诊主要症状为咳嗽、咳痰、胸痛4个月。胸部CT检查见右上叶后段-右下叶肿瘤性病变并阻塞性肺炎,右肺下叶转移瘤,纵隔、右肺门淋巴结增多、增大,右肺门软组织增厚;支气管镜检查病理活检明确诊断肺腺癌;二代测序基因检测结果提示棘皮动物微管样蛋白4-间变淋巴瘤激酶(echinoderm microtubule associated protein like 4-anaplastic lymphoma kinase,EML4-ALK)融合伴随肿瘤蛋白53(tumor protein 53,TP53)和视网膜母细胞瘤1(retinoblastoma 1,RB1)基因突变。给予二代ALK-TKI阿来替尼靶向治疗,无进展生存期11个月。随后出现疾病进展,考虑对阿来替尼耐药,改为三代ALK-TKI洛拉替尼靶向治疗1个月无效,疾病快速系统性进展,神经元特异性烯醇化酶(neuron specific enolase,NSE)明显升高,短期内新发胸膜、心包、颅内、肝脏、骨转移。二次活检的结果提示为小细胞肺癌,更改治疗方案为化学治疗联合免疫治疗,症状缓解。ALK-TKI治疗ALK融合的晚期非小细胞肺癌耐药机制复杂,病理类型小细胞转化也是耐药机制之一,发生率极低,伴随TP53和RB1基因突变可能是其向小细胞转化的特征,NSE异常升高是腺癌向小细胞转化有预测作用的血清标志物,耐药后及时进行二次活检,根据不同耐药机制选择后续治疗对疾病全程管理非常重要。
文摘目的探讨系统性ALK阴性间变性大细胞淋巴瘤(anaplastic large cell lymphoma,ALCL)的临床病理特点、分子特征、治疗和预后。方法回顾性分析18例系统性ALK^(-)ALCL的临床病理特征、免疫表型特点,行HE、免疫组化染色、FISH和NGS检测,并复习相关文献。结果系统性ALK^(-)ALCL好发于老年男性,常位于进展期,以淋巴结病变为主,结外原发部位包括原发胰腺、原发胸椎;形态学显示17例呈普通型,1例呈“霍奇金样”型。免疫表型:肿瘤细胞中CD30均弥漫强阳性(>75%),CD2(16/17)、CD3(13/18)、CD5(4/18)、CD7(8/18)、CD4(14/18)、TIA-1(16/18)、CD8(2/16)、GATA-3(10/12)、EMA(3/5)、MUM1(12/12)、CD43(6/6)和CD56(2/8)不同程度阳性,Ki67增殖指数30%~90%,PD-L1(22C3)(TPS=0~100%),ALK、CD15、CD79α和CD20均阴性;FISH检测:5例TP63缺失,2例DUSP22缺失。NGS检测:16例发生基因突变,基因突变频率0~11个,平均4.2个基因突变;伴TP63重排的ALK^(-)ALCL更易发生于女性,多发于淋巴结,临床分期晚,易伴p53基因异常。结论伴TP63重排的系统性ALK^(-)ALCL与诸多不良因素相关,临床过程多呈侵袭性,预后不佳。
基金supported by the National Natural Science Foundation(81900070)the Natural Science Foundation of Hunan Province(2020JJ5813)China。
文摘The genomic fusions of the anaplastic lymphoma kinase(ALK)gene have been widely recognized as effective therapeutic targets for non-small cell lung carcinoma(NSCLC).The Second Xiangya Hospital of Central South University has treated 2 NSCLC patients with 2 distinct novel ALK gene fusions.Case 1 was a 55-year-old male with a solid nodule located in the right hilar lobe on enhanced CT scan.Case 2 was a 47-year-old female with enhanced CT showing involvement of the left upper lobe of lung.Histopathological examination of tumor tissues confirmed lung adenocarcinoma in both cases.Immunohistochemical(IHC)staining demonstrated positivity for thyroid transcription factor 1(TTF-1)and ALK-D5F3 in tumor cells,while negativity for P40.The next-generation sequencing(NGS)tests identified a PNPT1-ALK(Exon22:Exon20)fusion variant in case 1 and a TCEAL2-ALK(Exon3:Exon19)fusion variant in case 2.The TCEAL2-ALK fusion was further confirmed by amplification refractory mutation system(ARMS)-PCR at the mRNA level.Both patients were treated with oral alectinib at a dosage of 600 mg twice daily.The tumors in both patients were significantly decreased after alectinib treatment,achieving partial response.At the time of submission,there was an absence of disease progression and the progression-free survival(PFS)had surpassed 1 year.It offered compelling evidences that the individuals with NSCLC and harboring either a PNPT1-ALK(Exon22:Exon20)fusion or a TCEAL2-ALK(Exon3:Exon19)fusion,experience favorable therapeutic outcomes through the administration of alectinib.This study expands the known ALK fusion variants database and supports the precision treatment of NSCLC using ALK tyrosine kinase inhibitors(TKIs).
