{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:16:03Z","timestamp":1786115763312,"version":"build-2736575974"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"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. Pediatr."],"abstract":"<jats:p>The concurrent occurrence of two histogenetically distinct tumors in a child is exceptionally uncommon and may create substantial diagnostic uncertainty. To the best of our knowledge, this is the first reported case of synchronous diagnosis of an ALK-rearranged inflammatory myofibroblastic tumor (IMT) of the larynx and EGFR-mutant lung adenocarcinoma. A 7-year-old boy presented with dyspnea and hoarseness. A laryngeal mass was resected and confirmed to be ALK-positive IMT harboring a THBS1-ALK rearrangement. PET-CT also detected a solitary lung nodule in the right lower lobe, which was initially considered possible metastatic IMT. However, serial chest CT over 22 months demonstrated only minimal, indolent enlargement, a pattern that was inconsistent with the expected behavior of metastatic disease. Because of this clinicoradiologic discrepancy, thoracoscopic wedge resection was performed for definitive diagnosis. Histopathology revealed acinar-predominant invasive adenocarcinoma of the lung that was positive for TTF-1, and Napsin A, and negative for ALK. Next-generation sequencing identified an EGFR exon 20 insertion (p.N771_P772insG) and a low tumor mutational burden. The discordant clinical behavior, isolated and indolent radiologic evolution, divergent histopathologic and immunophenotypic profiles, and distinct oncogenic drivers collectively supported a diagnosis of synchronous primary tumors rather than metastatic IMT. Because sequencing was limited to the DICER1 hotspot region, other hereditary cancer-predisposition mechanisms could not be definitively excluded. This case underscores the importance of longitudinal imaging, integrated pathology, and molecular profiling when presumed metastatic disease follows an atypical course pediatric oncology.<\/jats:p>","DOI":"10.3389\/fped.2026.1874110","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:33:08Z","timestamp":1785994388000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Synchronous ALK-positive laryngeal inflammatory myofibroblastic tumor and EGFR-mutant lung adenocarcinoma in a child"],"prefix":"10.3389","volume":"14","author":[{"given":"Guodun","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, West China Hospital of Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dengke","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, West China Hospital of Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taozhen","family":"He","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, West China Hospital of Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miao","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, West China Hospital of Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, West China Hospital of Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyi","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, West China Hospital of Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, West China Hospital of Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1097\/00000478-199508000-00001","article-title":"Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). 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