LAUSR

To the Editor, A 71-year-old nonsmoking female was admitted to our hospital with a persistent left gingival mass which had been increasing in size for 2 weeks. The mass had dramatically increased in size, approximately doubling in size in a week, and was accompanied by moderate pain in the left palate gingiva not relieved by oral ibuprofen. Physical examination revealed a cauliflower-like, 3 3 cm mass located beside the left upper palate arch near the buccal membrane gingiva (Figure 1(a)). The patient had been diagnosed with advanced lung adenocarcinoma with EML4-ALK fusion 1 year previously. Oral alectinib 600 mg twice a day has been used for almost 1 year and had been well tolerated. Radiological evaluation demonstrated disease progression with an enlarged primary mass and newly diagnosed lung metastasis (Figure 1(c)) compared with the best response to alectinib (Figure 1(b)). No other specific symptoms were reported and blood tests including CEA were almost within the normal range apart from the white blood cell count which was 10.77 10/l. Computed-tomography (CT) guided tissue biopsy was performed of the right lung nodule with a subsequent histopathological diagnosis of lung adenocarcinoma (Figure 1(d),