Abstract
A 47-year-old white Hispanic man with a never smoking history was incidentally found to have a right-sided pulmonary nodule, hilar, and mediastinal adenopathy. Sampling of level 10R, 11R, and 7 nodal stations disclosed a carcinoma (Figure 1A) that stained positive, by immunohistochemistry, for thyroid transcription factor 1 (Figure 1B), transformation-related protein 63 (P63; Figure 1C), and cytokeratin (CK5/6; Figure 1D). By using the newly accepted IASLC/ERS classification for lung cancers, the tumor was best classified as a non-small cell lung cancer (NSCLC), not otherwise specified, possible adenosquamous carcinoma1; because it had both adenocarcinoma (thyroid transcription factor 1) and squamous cell carcinoma (P63, CK5/6) markers. There was no evidence of extrathoracic tumor involvement, and the patient was felt to have stage III NSCLC. The tumor had no epidermal growth factor receptor or V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) gene mutations. A break-apart fluorescence in situ hybridization probe for the anaplastic lymphoma kinase (ALK) demonstrated an ALK translocation.
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