title: Ground-glass nodule in a patient with echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK)-positive lung cancer: a case report.
abstract: BACKGROUND
  Grand-glass nodule for CT image has thought to be less aggressive tumor in lung cancer. Echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK)-positive lung cancer presenting with Ground-glass nodules (GGNs) is relatively rare, and few such cases have been reported.
  
  
  METHODS
  An asymptomatic 56-year-old woman exhibited a 1.1-cm GGN in the lower lobe of the left lung on computed tomography during a medical checkup. Positron emission tomography showed no difference in uptake by the nodule compared with other organs. We elected to perform surgery because the nodule included a solid component and had grown only slightly during the last 2 years according to thin-section computed tomography. Partial resection of the lower left lung was performed by video-assisted thoracic surgery. Pathological examination revealed mucus-producing high columnar epithelium forming an irregular tubular-acinar-like structure partly replacing the alveolar epithelium on hematoxylin and eosin staining. More than 50 % of the tumor demonstrated a lepidic growth pattern. The tumor was negative for epidermal growth factor receptor mutation but positive for the EML4-ALK fusion oncogene according to fluorescence in situ hybridization.
  
  
  CONCLUSIONS
  We herein report a case of EML4-ALK-positive lung cancer presenting with a GGN along with a review of the relevant literature, including histopathological findings and imaging features. We consider that EML4-ALK-positive lung cancer is often highly progressive and that careful follow-up is therefore essential in these patients.
authors.affiliation: Department of Thoracic Surgery, Takeda General Hospital, Fukushima, Japan.|Department of Regenerative Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Owada
authors.affiliation: Department of Thoracic Surgery, Takeda General Hospital, Fukushima, Japan.|Department of Regenerative Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yonechi
authors.affiliation: Department of Regenerative Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Higuchi
authors.affiliation: Department of Regenerative Surgery, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. hiro@fmu.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000473:pathology*; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology*; D008875:Middle Aged; D015514:Oncogene Proteins, Fusion / Q000235:genetics*; D011379:Prognosis; D014057:Tomography, X-Ray Computed
chemical_list: C522504:EML4-ALK fusion protein, human; D015514:Oncogene Proteins, Fusion
keywords: EML4-ALK-positive; Ground-glass nodule; Lung cancer; Surgery