Participant Instructions: Welcome to the Molecular Oncology Tumor Board Series! This educational initiative is a collaboration between the American Society of Clinical Oncology (ASCO), College of American Pathologists (CAP), and Association for Molecular Pathology (AMP).
A new case will be presented every other month with discussions led by an expert pathologist and medical oncologist. This month’s topic is led by Drs. Lynette Sholl (Pathologist from Brigham and Women’s Hospital) and Apar Ganti (Medical Oncologist from University of Nebraska Medical Center).
This discussion is built upon a hypothetical, lung cancer patient case that was suggested by a Molecular Oncology Tumor Board participant. Do you have an interesting case in mind? Submit your hypothetical patient cases for consideration in an upcoming Molecular Oncology Tumor Board discussion forum.
Participants are encouraged to leave comments and post questions about the case in order to generate a wide discussion among the cancer care community. You can also receive email notifications when new comments are posted by clicking the “Follow this Conversation” option located at the bottom of this page.
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Patient Case
A 70-year-old never smoker male patient was in his normal state of health until approximately 2 months ago when he developed progressively worsening low back pain. He did not have any radiating symptoms of sciatica, lower extremity weakness, incontinence or saddle anesthesia. He was then referred to Orthopedic Surgery for further evaluation. He had a lumbar spine MRI that displayed multiple lesions. A biopsy of the lumbar spine confirmed adenocarcinoma, most likely, lung primary. Immunostaining showed that the tumor was diffusely positive for keratins (AE1/3, K903 and CK7), TTF-1 and napsin, and negative for CK20, PSA, PAP, CDX-2, CD10, ERG and CD45. CT scan showed mediastinal and hilar adenopathy, micro-nodularity in the lung along with patchy consolidation in the lower lobes. He was started on palliative radiation to his lumbar spine for pain control. He received a lung biopsy, which was positive for rearrangement of the ALK (2p23) locus (40.5%). He was started on crizotinib and showed a partial response. His functional status improved significantly (PS ECOG -2 to ECOG – 0 in about 3 months) and he remained on it for 20 months.