Diffuse cerebral infarction due to massive thromboembolism in a young male patient with ALK-positive non-small cell lung cancer: Is the ALK rearrangement related to thrombosis?

IntroductionThe risk of thromboembolism is increased in cancer patients and its incidence varies in different tumor types (1). Thromboembolic events are common in lung cancer and are relatively higher in adenocarcinoma than in other subtypes (2). Driver mutations in lung adenocarcinoma affect the behavior of cancer and the prognosis of the disease. In addition, these different genomic mutations have been found to be associated with thromboembolic events at varying rates. Anaplastic lymphoma kinase (ALK) rearrangement is detected in approximately 5% of patients with non-small cell lung cancers (NSCLC), and targeted tyrosine kinase therapies can be used in these patients (3). Patients with ALK rearrangement have an increased risk of both venous and arterial thrombosis (4). The risk of venous thromboembolism was found to be 3 to 5 times higher in patients with ALK rearrangement (5). However, there is limited information about arterial thromboembolism risk and mechanism in this patient group with driver mutation. The mechanism of thromboembolism in patients with ALK rearrangement is still unclear. Here, we present a case of diffuse brain infarction due to massive thromboembolism in a young male patient with ALK-positive non-small cell lung cancer.