A 61-year-old male patient was simultaneously diagnosed with lung adenocarcinoma and inflammatory myofibroblastic tumor (IMT). The lung adenocarcinoma and IMT harbored two distinct types of ALK translocation, LOC101927285-ALK, and TPM3-ALK, respectively. The ALK Ventana showed strong positivity on both lesions. The patient was therefore given an endobronchial cryotherapy and ALK inhibitor crizotinib. The tumors showed durable response however the left lung adenocarcinoma relapsed at 17th month post-crizotinib treatment. Tissue re-biopsy on the resistant tumor revealed an ALK exon 23 C1156Y missense mutation in addition to LOC101927285-ALK mutation. Further RNA-based sequence uncovered that the noncoding region rearrangement is the fusion mutation of EML4-ALK. The patient was therefore received alectinib, and the tumor exhibited partly response. Overall, it is very rare that two types of pulmonary tumors exist in one patient driven by two distinct ALK fusions, which emphasizes the necessity of gene sequencing in clinical decision-making and individualized therapy.

A 61-year-old male patient was simultaneously diagnosed with lung adenocarcinoma and inflammatory myofibroblastic tumor (IMT). The lung adenocarcinoma and IMT harbored two distinct types of ALK translocation, LOC101927285-ALK, and TPM3-ALK, respectively. The ALK Ventana showed strong positivity on both lesions. The patient was therefore given an endobronchial cryotherapy and ALK inhibitor crizotinib. The tumors showed durable response however the left lung adenocarcinoma relapsed at 17th month post-crizotinib treatment. Tissue re-biopsy on the resistant tumor revealed an ALK exon 23 C1156Y missense mutation in addition to LOC101927285-ALK mutation. Further RNA-based sequence uncovered that the noncoding region rearrangement is the fusion mutation of EML4-ALK. The patient was therefore received alectinib, and the tumor exhibited partly response. Overall, it is very rare that two types of pulmonary tumors exist in one patient driven by two distinct ALK fusions, which emphasizes the necessity of gene sequencing in clinical decision-making and individualized therapy.

Objective To explore the clinical value of 18F-fluorodeoxyglucose (FDG) PET/CT in assessing antineutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods Fifteen patients (7 males,8 females,age (66±11) years) with AAV between January 2015 and June 2017 were retrospectively analyzed.There were 6 patients diagnosed as granulomatosis with polyangiitis (GPA),7 diagnosed as microscopic polyangiitis (MPA) and 2 diagnosed as eosinophilic granulomatosis with polyangiitis (EGPA).All patients underwent 18 F-FDG PET/CT and the image features were observed and analyzed.The maximum standardized uptake value (SUVmax) of the positive lesion was measured.The relationship between the SUVmax and C reactive protein (CRP) was analyzed with Pearson correlation.The SUVmax and the number of lesion sites were compared by two-sample t test between the CRP-elevated and CRP-normal patients.Results A total of 56 lesions in the 14 of 15 AAV patients were detected by PET/CT.The positive findings distributed in 15 tissues and organs,including the nasopharynxes (n =9),lungs (n =9),kidneys (n =8),spleen (n =6),lymph nodes (n =6),bone marrow (n =4),skin (n =3),prostate (n =2),aortas (n =2),vertebral soft tissues (n =2),orbita (n =1),parotid gland (n =1),thyroid gland (n =1),liver (n =1) and pancreas (n=1).The 60.7％ (34/56) of lesions were clinically unsuspected occult lesions.GPA lesions mainly invaded the nasopharynxes,lungs and kidneys;MPA lesions mainly invaded the kidneys and spleen;EGPA lesions mainly invaded the nasopharynxes,lymph nodes and bone marrow.There was no significant correlation between the level of CRP and the SUVmax of AAV lesions (r=0.462,P＞0.05).No differences in the SUVmax were observed between patients with elevated CRP levels and those with normal CRP levels (t=1.451,P＞0.05).But more lesion sites were observed in patients with elevated CRP (t=3.456,P＜0.05).Conclusions 18F-FDG PET/CT shows positive findings in multiple sites in AAV patients,including clinically unsuspected sites.This imaging technique may be a useful tool for diagnosis and evaluation of AAV.