免疫高表达型继发“钻石突变”的晚期非小细胞肺癌的病例报告
Case Report of Advanced Non-Small Cell Lung Cancer with Immunohyperexpression Secondary to “Diamond Mutations”

本文报告1例免疫高表达的晚期肺腺癌多发转移的42岁男性病例，该患者为左肺腺癌IV期，淋巴结、肝、骨多发转移，穿刺标本二代测序肺癌基因未见检测突变，免疫组化提示PD-L1高表达(90%)，行免疫联合治疗，经多周期治疗后，患者肺的原发病灶、淋巴结、肝脏、骨相关转移病灶全部消失。32个月后出现锁骨下淋巴结融合增大，再次行淋巴结穿刺活检提示肿瘤转移，行基因检测提示ALK融合突变，口服靶向治疗后，现复查锁骨下淋巴结全部消失。
This article reports a 42-year-old male case with multiple metastases of advanced lung adenocarcinoma with high immune expression, and the patient had stage IV adenocarcinoma of the left lung, lymph nodes, liver, multiple bone metastases, no mutations were detected in the lung cancer gene by the second-generation sequencing of the puncture specimens, and immunohistochemistry showed high expression of PD-L1 (90%). After multiple cycles of treatment, the primary lesions, lymph nodes, liver, and bone-related metastases of the patient’s lungs all disappeared. After 32 months, the subclavian lymph node fusion is enlarged, and the lymph node biopsy showed tumor metastasis again, and the genetic test showed ALK fusion mutation, which was taken orally. After targeted therapy, all subclavian lymph nodes disappeared after reexamination.