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Background Methods Results Conclusion Screening for anaplastic lymphoma kinase (ALK) rearranged non‐small cell lung cancer (NSCLC) is crucial for identifying patients eligible for targeted therapy. The FDA‐approved ALK (D5F3) immunohistochemistry (IHC) assay, used with the OptiView Amplification Kit, demonstrates excellent sensitivity and specificity in detecting these patients. However, the clinical significance of resulting focal positivity remains unclear, and ALK (D5F3) expression unrelated to ALK fusion is observed in some cases of neuroendocrine differentiation. This study aims to validate these findings with molecular testing and contribute to the accurate interpretation of ALK (D5F3) IHC results.A total of 1619 patients diagnosed with NSCLC and neuroendocrine carcinoma were evaluated using ALK (D5F3) IHC. For cases with strong but focal expression and those with diffuse strong positivity in neuroendocrine differentiation, ALK fluorescence in situ hybridization (FISH) and/or next‐generation sequencing (NGS) tests were performed.Seven out of 1109 adenocarcinomas (0.6%) and six out of 289 squamous cell carcinomas (2.1%) exhibited strong focal ALK (D5F3) expression. Nine out of 209 neuroendocrine carcinomas (4.3%) showed homogeneously strong ALK (D5F3) expression. All these cases, including adenocarcinoma with neuroendocrine differentiation and combined small cell carcinoma, were negative for ALK fusions by FISH and/or NGS.This study demonstrates that strong but focal ALK (D5F3) immunostaining and strong expression in neuroendocrine differentiation may not indicate ALK fusion. By considering these findings, we can improve the accuracy of patient selection for targeted therapy by minimizing false‐positive interpretations of ALK (D5F3) staining. [ABSTRACT FROM AUTHOR]

Background Pulmonary thromboembolism and active haemoptysis represent distinct yet critical emergencies necessitating immediate intervention. However, the treatment protocols for these conditions—anticoagulation therapy and haemostatic therapy—often pose a dilemma. Case summary We present the case of a 25-year-old female who presented to our emergency room with haemoptysis and a concurrent diagnosis of pulmonary thromboembolism. Due to persistent active haemoptysis, we temporarily paused anticoagulation and opted for surgical pulmonary thrombectomy, enabling the safe resumption of anticoagulation therapy. Discussion Haemoptysis occurring in pulmonary thromboembolism is infrequently reported in the literature, and established treatment guidelines for such cases are lacking. This case could provide guidance on how to handle the intricate treatment challenges posed by concurrent haemoptysis and pulmonary thromboembolism. [ABSTRACT FROM AUTHOR]

Background: Pulmonary mucosa‐associated lymphoid tissue (MALT) lymphoma sometimes presents as large pulmonary nodules composed of small nodular opacities (galaxy sign) on computed tomography (CT). The aim of this study was to assess the presence, usefulness, and pathological characteristics of the galaxy sign on CT of pulmonary MALT lymphoma. Methods: From January 2011 to December 2021, chest CTs of 43 patients with pulmonary MALT lymphoma were reviewed by two radiologists for the galaxy sign and various other findings. Interreader agreement to characterize the galaxy sign and factors associated in making a correct first impression on CT prior to pathological diagnosis were assessed. Resected specimens were reviewed by two pathologists, and the proportion of peripheral lymphoma infiltrates was compared between lesions with and without the galaxy sign. Results: Of 43 patients, 22 patients (44.2%) showed the galaxy sign (κ = 0.768, p < 0.0001). The galaxy sign (p = 0.010) was associated with making a correct first impression on CT prior to pathological diagnosis. On pathological examination, lesions showing the galaxy sign on CT demonstrated a significantly higher proportion of peripheral lymphoma infiltrates (p = 0.001). Conclusion: The galaxy sign can be seen on CT of pulmonary MALT lymphoma with a higher proportion of peripheral lymphoma infiltrates and may be useful in making a correct diagnosis of pulmonary MALT lymphoma. [ABSTRACT FROM AUTHOR]

Purpose: To comprehensively evaluate qualitative and quantitative features for predicting invasiveness of pure ground-glass nodules (pGGNs) using multiplanar computed tomography. Methods: Ninety-three resected pGGNs (16 atypical adenomatous hyperplasia [AAH], 18 adenocarcinoma in situ [AIS], 31 minimally invasive adenocarcinoma [MIA], and 28 invasive adenocarcinoma [IA]) were retrospectively included. Two radiologists analyzed qualitative and quantitative features on three standard planes. Univariable and multivariable logistic regression analyses were performed to identify features to distinguish the pre-invasive (AAH/AIS) from the invasive (MIA/IA) group. Results: Tumor size showed high area under the curve (AUC) for predicting invasiveness (.860,.863,.874, and.893, for axial long diameter [AXLD], multiplanar long diameter, mean diameter, and volume, respectively). The AUC for AXLD (cutoff, 11 mm) was comparable to that of the volume (P =.202). The invasive group had a significantly higher number of qualitative features than the pre-invasive group, regardless of tumor size. Six out of 59 invasive nodules (10.2%) were smaller than 11 mm, and all had at least one qualitative feature. pGGNs smaller than 11 mm without any qualitative features (n = 16) were all pre-invasive. In multivariable analysis, AXLD, vessel change, and the presence or number of qualitative features were independent predictors for invasiveness. The model with AXLD and the number of qualitative features achieved the highest AUC (.902, 95% confidence interval.833-.971). Conclusion: In adenocarcinomas manifesting as pGGNs on computed tomography, AXLD and the number of qualitative features are independent risk factors for invasiveness; small pGGNs (<11 mm) without qualitative features have low probability of invasiveness. [ABSTRACT FROM AUTHOR]

Background: It is sometimes challenging to differentiate between gastrointestinal (GI) mucosal melanoma and gastrointestinal stromal tumors (GISTs) because they share some similarities in histological and molecular features. In this study, we investigated their clinicopathological and molecular features., Methods: Four primary GI mucosal melanomas and 4 atypical GISTs resected from 2017 to 2019 were included. Electronic medical records and histology slides were reviewed and, if needed, immunohistochemical stainings were additionally done. Somatic mutations were analyzed using whole exome sequencing (WES) with tumors and matched normal tissues., Results: By immunohistochemistry, GISTs were positive for CD117 (4 of 4), DOG1 (4 of 4), and CD34 (2 of 4). In contrast, melanomas were positive for CD117 (2 of 4), HMB-45 (4 of 4), Melan-A (4 of 4), and S100 protein (3 of 4). Using WES, the KIT mutation was detected in 2 of 4 GISTs and 1 of 4 melanomas, all of which showed strong CD117 immunoreactivity. PDGFRA mutation was detected in 2 of 4 GISTs but 0 of 4 melanomas. TP53, NF1, RB1, TERT, and KMT2D mutations were detected in 1 of 4 melanomas but 0 of 4 GISTs. A patient with KIT-mutated melanoma was treated with Gleevec and has remained disease-free for 1 year., Conclusions: GISTs and GI melanomas have a wide histopathological spectrum. Appropriate ancillary studies can be helpful for proper diagnosis and optimal treatment., Competing Interests: Conflict of Interest statement The authors declare that they have no conflict of interest., (Copyright © 2022 Elsevier GmbH. All rights reserved.)