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Atypical non-enhancing brain metastases from ALK-positive non-small cell lung carcinoma.

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Neurocirugia 2026 p. 500758
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Solmaz S, Gulsever CI

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Brain metastases are a frequent complication of advanced non-small cell lung carcinoma (NSCLC), particularly in anaplastic lymphoma kinase (ALK)-positive cases, which show a strong tendency for centra

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APA Solmaz S, Gulsever CI (2026). Atypical non-enhancing brain metastases from ALK-positive non-small cell lung carcinoma.. Neurocirugia, 500758. https://doi.org/10.1016/j.neucie.2026.500758
MLA Solmaz S, et al.. "Atypical non-enhancing brain metastases from ALK-positive non-small cell lung carcinoma.." Neurocirugia, 2026, pp. 500758.
PMID 41579961 ↗

Abstract

Brain metastases are a frequent complication of advanced non-small cell lung carcinoma (NSCLC), particularly in anaplastic lymphoma kinase (ALK)-positive cases, which show a strong tendency for central nervous system spread. Typically, such metastases demonstrate contrast enhancement on magnetic resonance imaging (MRI) due to disruption of the blood-brain barrier. We report a 45-year-old man with ALK-positive NSCLC presenting with a right temporal swelling and multiple non-contrast-enhancing brain lesions detected before any treatment. The temporal mass was excised and confirmed as metastatic adenocarcinoma. The patient received whole-brain radiotherapy (30Gy in 10 fractions), cisplatin-pemetrexed chemotherapy, and sequential targeted therapy with alectinib and lorlatinib. During three years of follow-up, MRI showed complete resolution of all lesions, and the patient remained neurologically intact and systemically stable. This case underscores the rarity of non-enhancing brain metastases in ALK-positive NSCLC and highlights the importance of recognizing this atypical imaging presentation for timely diagnosis and management.

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