Early-stage non-small cell lung cancer

Introduction: A 42-year-old male, former smoker (25 pack-years), with no cardiovascular history, was incidentally diagnosed with a pulmonary nodule in the lingula during a preoperative evaluation. High-resolution CT (HRCT) revealed a solid nodule measuring 28 × 16 mm, with moderate uptake on PET-CT (SUVmáx 3.49) and no suspicious lymphadenopathy. Spirometry showed mild obstruction. A percutaneous biopsy confirmed an invasive mucinous adenocarcinoma. The case was discussed by a multidisciplinary tumor board. Case report: The patient underwent left upper lobectomy with lymphadenectomy. Postoperative pathological analysis revealed a 4 cm tumor with STAS, clear surgical margins, and lymph node involvement in stations 5 and 10L (pT2a pN2 M0, stage IIIA). Immunohistochemistry revealed an ALK-EMK4 v3b fusion, confirmed by next-generation sequencing (NGS). Staging was completed with brain MRI and PET-CT, with no evidence of metastasis. Based on these findings and the results of the ALINA trial, adjuvant treatment with alectinib was initiated in January 2025. The patient remains recurrence-free with good treatment tolerance. Conclusion: This case highlights the importance of complete surgical staging and the value of early molecular testing. Preoperative identification of ALK+ status could significantly influence both diagnostic and therapeutic strategies.