Sub-clonal evolution of tumor in patient 1 through the course of diagnosis and treatment.
Serial whole genome sequencing (83–107X) of the pre-treatment and post-treatment primary adrenal tumor as well as metastases from CNS, liver, and bilateral lungs indicated that there was branching evolution leading to subclones with distinct driver mutations confined to different tumor sites. The BRAF V600E mutation was found in the post-treatment adrenal tumor only, while CNS tumors and lung/liver tumors had two different ALK mutations, F1174L and F1245I, respectively.