title: A Poorly Differentiated Malignant Neoplasm Lacking Lung Markers Harbors an EML4-ALK Rearrangement and Responds to Crizotinib.
abstract: Suspected metastatic site lesions that are poorly differentiated present a diagnostic challenge when morphologic and immunohistochemical profiling cannot establish the primary tumor site. Here we present a patient diagnosed with both a malignant neoplasm in the lung and a right upper extremity (RUE) neoplasm of unclear histogenetic origin. Immunohistochemical staining performed on the latter specimen was inconclusive in determining the site of origin. Although the lung biopsy sample was insufficient for molecular testing, hybrid capture-based comprehensive genomic profiling (FoundationOne) identified an EML4-ALK rearrangement in the RUE lesion. Crizotinib treatment resulted in a major response in both the RUE and the lung lesions. This report illustrates the utility of comprehensive genomic profiling employed at the initial presentation of an unknown primary malignant neoplasm, which resulted in the front-line use of targeted therapy and a significant and sustained antitumor response.
authors.affiliation: Foundation Medicine, Inc., Cambridge, Mass., USA.
authors.forename: Jon H
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Foundation Medicine, Inc., Cambridge, Mass., USA.
authors.forename: Siraj M
authors.initials: SM
authors.lastname: Ali
authors.affiliation: Affliated Pathology Services, N.Y., USA.
authors.forename: Jenni
authors.initials: J
authors.lastname: Davis
authors.affiliation: Affliated Pathology Services, N.Y., USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Robstad
authors.affiliation: Albany Medical College, Albany, N.Y., USA.
authors.forename: Richard
authors.initials: R
authors.lastname: McNally
authors.affiliation: Foundation Medicine, Inc., Cambridge, Mass., USA.
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Gay
authors.affiliation: Foundation Medicine, Inc., Cambridge, Mass., USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Erlich
authors.affiliation: Foundation Medicine, Inc., Cambridge, Mass., USA.
authors.forename: Norma A
authors.initials: NA
authors.lastname: Palma
authors.affiliation: Affliated Pathology Services, N.Y., USA.
authors.forename: Phil J
authors.initials: PJ
authors.lastname: Stephens
authors.affiliation: Affliated Pathology Services, N.Y., USA.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Miller
authors.affiliation: Cutugno Hematology Oncology, Kingston, N.Y., USA.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Cutugno
authors.affiliation: Foundation Medicine, Inc., Cambridge, Mass., USA ; Albany Medical College, Albany, N.Y., USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Ross
keywords: ALK; Crizotinib; Poorly differentiated lung neoplasm; Unknown primary tumor site