70 female stage IV LLL ALK-rearranged pulmonary adenocarcinoma metastatic to brain (on Lorlatinib) – inhibits the ALK protein, thyroid goiter s/p thyroidectomy (on Levothyroxine),

 

ALK-rearranged lung cancer. Testing for this fusion gene in NSCLC is important, as “ALK-positive” tumors (tumors harboring a rearranged ALK gene/fusion protein) are highly sensitive to therapy with ALK-targeted inhibitors.

 

 

BRAIN MRI 5 years ago

 

Multiple enhancing nodules with susceptibility artifact suggesting
blood products or mineralization seen in both frontal lobes, central
pons and left cerebellar hemisphere, highly concerning for brain
metastasis. No significant surrounding edema or midline shift. There
are additional 2 regions of enhancement within the cerebellar
hemispheres as described above, which may represent pulsation
artifact, however attention to this region on follow-up imaging is
recommended to evaluate for stability.

2.Scattered T2/FLAIR hyperintensities in the periventricular white
matter and corona radiata seen in the setting of chronic small vessel
disease.

 

 

Interval decrease in size in left lower lobe lesion within 6 months

6 years later LL collapse – No recurrence

 

Chronic PE