非小细胞肺癌（NSCLC）中分子分析的采用促进了罕见间基因重排等新型蛋白激酶（ALK）突变模式的发现。揭示这些融合物的结构及其对ALK抑制剂的反应在将来具有重要意义。关于因淋巴血行播散引起的房颤转移导致大脑缺血性卒中的报道非常稀缺。 一名35岁无动脉粥样硬化病史的女性突然出现复视和面瘫。脑MRI扫描显示双侧大脑中动脉供应的皮层和皮下区域多个梗死灶，经血管造影确诊为中动脉闭塞。经心脏超声检查发现心房内有附着物。经瓣膜剥离术后组织病理学显示二尖瓣和主动脉瓣的心内转移为肺癌。PET/CT发现右肺下叶原发肿瘤和纵隔淋巴结肿大。肺原发肿瘤的组织学提示腺癌，并进行了基于DNA的新一代测序（NGS）检测，在其中发现了一种间基因（FAM49A，RAD51AP2）-ALK（间基因：A14）重排。进一步的基于RNA的NGS发现了一种新型SLC34A2-ALK（外显子1：外显子15）融合。瓣膜手术后卒中复发，二尖瓣上再次出现瘤块。基于分子研究结果，给予阿莱替尼600mg口服两次/日，肿瘤明显缩小，神经症状大部分缓解。此后未再发现新的梗死灶或脑部转移。 我们报道了一例罕见的SLC34A2-ALK重排，该融合物对阿莱替尼有良好的反应。该病例为外周肺腺癌，因心内转移引起反复发作的缺血性卒中非常有趣。 版权所有 © 2023 Elsevier B.V.。保留所有权利。

The adoption of molecular profiling in non-small cell lung cancers (NSCLC) have promoted the discoveries of novel anaplastic lymphoma kinase (ALK) mutation patterns including rare intergenic rearrangements. It is always meaningful to report the structure of these fusions and their responses to ALK-inhibitors for future reference. Reports of cerebral ischemic strokes caused by atrial metastases through lymphohematogeneous spread are scarce.A 35-year-old woman with no history of astherosclerosis presented with sudden onset of diplopia and facial palsy. Brain MRI scan discovered multiple infarcts around cortical and subcortical areas supplied by bilateral middle cerebral arteries, the occlusions of which were confirmed by angiography. Echocardiogram revealed intracavity appendages in atriums. The histology following valve debridement displayed endocardial metastases from lung cancer on mitral and trucuspid valves. PET/CT found right lower lobe primary tumor and mediastinal lymphadenopathies. The histology of primary lung tumor suggested adenocarcinoma and a DNA-based next-generation sequencing (NGS) test uncovered an intergenic (FAM49A, RAD51AP2)-ALK (intergenic: A14) rearrangement. Further RNA-based NGS uncovered a novel SLC34A2-ALK (exon 1: exon 15) fusion. Strokes recurred after valve surgery and vegetations reappeared on the mitral valve. Alectinib 600 mg bid was administered based on molecular finding and achieved remarkable tumor regression. Neurologic symptoms were largely relieved. No new infarctions or cerebral metastases has ever been found since.We report a novel SLC34A2-ALK rearrangement responding well to alectinib in a very interesting case of peripheral lung adenocarcinoma presenting with recurrent cerebral ischemic strokes due to endocardial metastases.Copyright © 2023 Elsevier B.V. All rights reserved.