{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:11:26Z","timestamp":1753891886073,"version":"3.41.2"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Lung carcinomas usually spread to the liver, lungs, pleura, pericardium, adrenal glands, brain, and bones. Anaplastic lymphoma kinase gene (<jats:italic>ALK<\/jats:italic>) fusion occurs in approximately 5% of non-small cell lung cancer (NSCLC) cases and most frequently in adenocarcinoma. Here, we report a rare case of intestinal metastasis originating from pulmonary pleomorphic carcinoma in a 49-year-old male heavy smoker. At the local hospital, the patient was initially considered to have an ALK-positive intestinal tumor, leading to a differential diagnosis of inflammatory myofibroblastic tumor (IMT). Due to the tumor\u2019s peculiar morphology (including epithelioid and spindle cell components), pathologists of the local hospital sent slides of the case to our hospital for further consultation. Immunohistochemical analysis revealed that the epithelioid and spindle neoplastic cells were positive for CK7, TTF1, and ALK-V. Fluorescence <jats:italic>in situ<\/jats:italic> hybridization (FISH) confirmed the presence of the echinoderm microtubule-associated protein-like 4 (<jats:italic>EML4<\/jats:italic>):: <jats:italic>ALK<\/jats:italic> fusion. Based on these findings, we established the final diagnosis as intestinal metastasis of ALK-positive pulmonary pleomorphic carcinoma. A subsequent enhanced CT scan of the chest revealed a 3.0 cm solid mass in the right upper lung, further supporting the diagnosis of intestinal metastasis originating from pulmonary pleomorphic carcinoma. In conclusion, this case exhibited highly unusual clinicopathological features that could easily lead to misdiagnosis as primary intestinal tumors with <jats:italic>ALK<\/jats:italic> rearrangement. Pathologists must know this possibility to ensure accurate diagnosis and appropriate management.<\/jats:p>","DOI":"10.3389\/fonc.2025.1496752","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T05:55:23Z","timestamp":1743141323000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Intestinal metastasis from ALK-rearranged pulmonary pleomorphic carcinomas mimicking inflammatory myofibroblastic tumors"],"prefix":"10.3389","volume":"15","author":[{"given":"Changle","family":"Shi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kang","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuli","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingsong","family":"Wan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Yao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongying","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"volume-title":"WHO Classification of Tumor","year":"2021","key":"B1"},{"key":"B2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/PAI.0000000000001060","article-title":"The correlation between histologic, immunophenotypic, and molecular characteristics of pulmonary sarcomatoid carcinoma reveals that sarcomatoid change is potentially derived from epithelial carcinoma cells undergoing epithelial-mesenchymal transition","volume":"31","author":"Huang","year":"2023","journal-title":"Appl Immunohistochem Mol Morphol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/nature05945","article-title":"Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer","volume":"448","author":"Soda","year":"2007","journal-title":"Nature"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S1556-0864(15)30037-X","article-title":"Primary lung cancer presenting with gastrointestinal tract involvement: clinicopathologic and immunohistochemical features in a series of 18 consecutive cases","volume":"2","author":"Rossi","year":"2007","journal-title":"J Thorac Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.suronc.2006.05.004","article-title":"Small bowel obstruction caused by secondary tumors","volume":"15","author":"Idelevich","year":"2006","journal-title":"Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000213393.57322.c7","article-title":"Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features including ALK expression in atypical and aggressive cases","volume":"31","author":"Coffin","year":"2007","journal-title":"Am J Surg Pathol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2015.12.097","article-title":"A case of ALK-rearranged adenocarcinoma with small cell carcinoma-like transformation and resistance to crizotinib","volume":"11","author":"Cha","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e38839","article-title":"Small intestinal metastasis in a lung adenocarcinoma patient with concurrent EML4-ALK V3 and TP53 mutations after distinct responses to tyrosine kinase inhibitors: A case report","volume":"10","author":"Zhu","year":"2024","journal-title":"Heliyon"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1080\/17581966.2024.2364582","article-title":"Oncogenic ALK fusion in rare subtype of small intestine metastasis from occult lung cancer","volume":"14","author":"Liu","year":"2025","journal-title":"Lung Cancer Manag"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/path.4836","article-title":"ALK oncoproteins in atypical inflammatory myofibroblastic tumours: novel RRBP1-ALK fusions in epithelioid inflammatory myofibroblastic sarcoma","volume":"241","author":"Lee","year":"2017","journal-title":"J Patho"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3182233e06","article-title":"Comprehensive histologic analysis of ALK-rearranged lung carcinomas","volume":"35","author":"Yoshida","year":"2011","journal-title":"Am J Surg Pathol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2012.10.002","article-title":"Favorable clinical outcomes of pemetrexed treatment in anaplastic lymphoma kinase positive non-small-cell lung cancer","volume":"79","author":"Lee","year":"2013","journal-title":"Lung Cancer"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000311","article-title":"A novel mechanism of EML4-ALK rearrangement mediated by chromothripsis in a patient-derived cell line","volume":"9","author":"Kodama","year":"2014","journal-title":"J Thorac Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.54.4474","article-title":"A rare case of pleomorphic carcinoma of the lung harboring an anaplastic lymphoma kinase (ALK) rearrangement","volume":"54","author":"Shiroyama","year":"2015","journal-title":"Intern Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000450","article-title":"Response to crizotinib and clinical outcome in ALK-rearranged pulmonary pleomorphic carcinoma","volume":"10","author":"Murakami","year":"2015","journal-title":"J Thorac Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-014-0428-4","article-title":"Detection of ALK rearrangement in an octogenarian patient with pleomorphic carcinoma of the lung","volume":"64","author":"Maruyama","year":"2016","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2016.89","article-title":"Molecular characterization of pulmonary sarcomatoid carcinoma: analysis of 33 cases","volume":"29","author":"Jang","year":"2016","journal-title":"Mod Pathol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"3947","DOI":"10.1038\/s41598-017-04296-2","article-title":"Clinical significance and next-generation sequencing of Chinese pulmonary sarcomatoid carcinoma","volume":"7","author":"Li","year":"2017","journal-title":"Sci Rep"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.tranon.2016.11.009","article-title":"Pulmonary sarcomatoid carcinoma with ALK rearrangement: frequency, clinical-pathologic characteristics, and response to ALK inhibitor","volume":"10","author":"Chen","year":"2017","journal-title":"Transl Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1177\/0300060517748262","article-title":"Anaplastic lymphoma kinase (ALK)-rearranged pulmonary pleomorphic carcinoma successfully treated with crizotinib","volume":"46","author":"Lin","year":"2018","journal-title":"J\u00a0Int Med Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3536","DOI":"10.1038\/s41598-019-40016-8","article-title":"Whole\u00a0transcriptome targeted gene quantification provides new insights on pulmonary sarcomatoid carcinomas","volume":"9","author":"Al\u00ec","year":"2019","journal-title":"Sci Rep"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/1759-7714.13536","article-title":"Analysis of targeted somatic mutations in pleomorphic carcinoma of the lung using next-generation sequencing technique","volume":"11","author":"Manabe","year":"2020","journal-title":"Thorac Cancer"},{"key":"B23","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s40792-022-01408-7","article-title":"Successful salvage\u00a0surgery followed by second ALK-TKI after alectinib failure in a patient with\u00a0ALK-positive NSCLC","volume":"8","author":"Hashimoto","year":"2022","journal-title":"Surg Case Rep"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1002\/path.4950","article-title":"Molecular breakdown: a comprehensive view of anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer","volume":"243","author":"Noh","year":"2017","journal-title":"J Pathol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3960\/jslrt.17023","article-title":"Anaplastic large cell lymphoma: pathology, genetics, and clinical aspects","volume":"57","author":"Tsuyama","year":"2017","journal-title":"J Clin Exp Hematop"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2017.05.007","article-title":"Primary gastrointestinal anaplastic large cell lymphoma","volume":"49","author":"Lee","year":"2017","journal-title":"Pathology"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1496752\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T05:55:31Z","timestamp":1743141331000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1496752\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":26,"alternative-id":["10.3389\/fonc.2025.1496752"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1496752","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2025,3,28]]},"article-number":"1496752"}}