Progressive respiratory failure in a patient with wood dust exposure — a case report with an unexpected outcome of adenocarcinoma with ALK gene rearrangement

Abstract

Lung cancer remains the leading cause of cancer-related deaths among both men and women in Poland. There are various types of lung cancer, with non-small cell lung cancer (NSCLC) being the most prevalent. Within NSCLC, adenocarcinoma is the most common subtype. Lung adenocarcinoma poses significant challenges in effective treatment due to its complex molecular profile. Recently, significant advancements have been observed in targeted therapies for lung cancer, which are based on the molecular diagnosis of cancer subtypes. Patients with adenocarcinoma with ALK gene rearrangements have the possibility of effective therapy with ALK inhibitors, especially the third generation of these drugs — lorlatinib. Here, a 39-year-old male admitted to the documented clinic with symptoms of respiratory failure is presented. He had a long-term history of employment in the wood industry. The course of the disease was rapid and it did not allow for diagnosis and treatment before the patient’s death. In the autopsy material pneumonic type of lung adenocarcinoma (PLADC) was diagnosed, and immunohistochemical method revealed expression of aberrant ALK protein. This case report is the first according to the literature in which ALK gene rearrangement was found in a non-smoking, young patient exposed to wood dust.