Case Report: An HIV-Positive Woman Diagnosed with ALK Rearranged Lung Large-Cell Neuroendocrine Cancer with Unusual Metastasis

Background: Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is an exceedingly rare and aggressive type of lung cancer, often associated with metastasis to the brain, bones, adrenal glands and lymph nodes. To date, only a few cases of lung LCNEC with breast metastasis have been reported. Anaplastic lymphoma kinase (ALK) rearrangements occur in lung adenocarcinomas, but they are not typical for LCNEC and the median survival of LCNEC patients is approximately 1 year. Case presentation Here, we presented the case of an HIV-positive woman who was diagnosed with ALK-positive lung LCNEC from breast nodules. The patient responded dramatically to alectinib treatment. She showed an evidently longer median survival time than that reported previously, which suggests the benefit of using ALK inhibitors. Conclusions: Based on our case experience, we recommend next-generation sequencing (NGS) as a routine procedure for patients with LCNEC as it can provide more numbers of therapeutic alternatives.