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LETTER TO THE EDITOR
Year : 2015  |  Volume : 11  |  Issue : 4  |  Page : 1044

Bilateral axillary node metastases from anaplastic lymphoma kinase positive non-small cell lung cancer


Department of Internal Medicine, Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki, Japan

Date of Web Publication15-Feb-2016

Correspondence Address:
Hiroaki Satoh
Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Miya machi 3 2 7, Mito, Ibaraki - 3100015
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.139398

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How to cite this article:
Kurishima K, Kagohashi K, Satoh H. Bilateral axillary node metastases from anaplastic lymphoma kinase positive non-small cell lung cancer. J Can Res Ther 2015;11:1044

How to cite this URL:
Kurishima K, Kagohashi K, Satoh H. Bilateral axillary node metastases from anaplastic lymphoma kinase positive non-small cell lung cancer. J Can Res Ther [serial online] 2015 [cited 2020 Aug 11];11:1044. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1044/139398

Sir,

We read previously with very interest a report on a patient with isolated axillary lymph node metastasis in bronchogenic carcinoma by Krishnamurthy and Neelakantan (J Cancer Res Ther, Jan-Mar Issue, 2012). [1] We recently treated a similar patient, and would like to share our experience.

A 41-year-old, nonsmoking man was referred to our hospital due to both subclavian and axillary masses for a month. Physical examination revealed both subclavian and axillary mobile tumors up to 3 cm in diameter. Chest computed tomography (CT) scan showed a mass in the right upper lobe of the lung with ipsilateral hilar and mediastinal lymph node swelling. Bilateral axillary tumors were confirmed on chest CT scan and ultrasonography. Pathological examination using a biopsy sample obtained from the right subclavian nodes revealed adenocarcinoma. Immunochemical staining showed expression of thyroid transcription factor (TTF)-1 and cytokeratin 7 and 20. These findings were consistent with metastasis from primary lung cancer. Anaplastic lymphoma kinase (ALK) rearrangement was positive of fluorescence in situ hybridization. He received four courses of chemotherapy with carboplatin, pemetrexed, and bevacizumab, and partial response (PR) with shrinkage of the subclavian and axillary nodes was achieved. Then he received eight courses of maintenance therapy with pemetrexed and bevacizumab. After regrowth of these nodes, he had crizotinib and PR with re-shrinkage of these nodes was achieved. He is still well without any recurrence with crizotinib therapy.

A recent publication has demonstrated a correlation between the molecular oncogene status and the biological behavior in non-small cell lung cancer (NSCLC), resulting in distinct metastasis patterns. [2] Diem et al., reported a case of ALK-positive lung adenocarcinoma with an unusual gastric metastasis. [3] Bilateral axillary node metastasis from lung cancer was extremely rare. [1],[4] To our best knowledge, this is the first clinical presentation with bilateral axillary node metastasis in an ALK-positive lung cancer patient. This supports the observation that unusual metastatic pattern in such molecular oncogene status patients. [2] Physicians must consider the possibility of ALK-positive NSCLC and perform molecular testing of AKL in NSCLC patients with uncommon metastatic sites including axillary nodes.



 
 > References Top

1.
Krishnamurthy A, Neelakantan V. Isolated axillary lymph node metastasis at presentation in bronchogenic carcinoma. J Cancer Res Ther 2012;8:161-2.  Back to cited text no. 1
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2.
Doebele RC, Lu X, Sumey C, Maxson DA, Weickhardt AJ, Oton AB, et al. Oncogene status predicts patterns of metastatic spread in treatment-naïve nonsmall cell lung cancer. Cancer 2012;118:4502-11.  Back to cited text no. 2
    
3.
Diem S, Früh M, Rodriguez R, Liechti P, Rothermundt C. EML4-ALK-Positive pulmonary adenocarcinoma with an unusual metastatic pattern: A case report. Case Rep Oncol 2013;6:316-9.  Back to cited text no. 3
    
4.
Satoh H, Ishikawa H, Kagohashi K, Kurishima K, Sekizawa K. Axillary lymph node metastasis in lung cancer. Med Oncol 2009;26:147-50.  Back to cited text no. 4
    




 

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