A case report of primary pleomorphic lung cancer with an atypical presentation

Sailaja Kambampati; N. Ram Joshna; Roja Prasanthi Prathipati; Anitha Patil; Sravani Avanigadda; Vijaya Tourani

doi:10.18203/2320-6012.ijrms20231663

Authors

Sailaja Kambampati Pulmonology Department, Mediciti Institute of Medical Sciences, Medchal, Telangana, India; Department of Pulmonology, Care Hospitals, Hyderabad, Telangana, India
N. Ram Joshna Department of Pulmonology, Mediciti Institute of Medical Sciences, Medchal, Telangana, India
Roja Prasanthi Prathipati Department of Anesthesiology, Case Western Reserve University; Department of Anesthesiology, Cleveland, Ohio, USA; Department of Pulmonology, Mediciti Institute of Medical Sciences, Medchal, Telangana, India
Anitha Patil Pulmonology Department, Mediciti Institute of Medical Sciences, Medchal, Telangana, India
Sravani Avanigadda Department of General Medicine, Government General Hospital, Vijayawada, Andhra Pradesh, India
Vijaya Tourani Department of Pathology, Care Hospitals, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20231663

Keywords:

IHC markers, PET scan, Pleomorphic pulmonary carcinoma, Rare primary lung carcinoma

Abstract

Pulmonary pleomorphic carcinoma (PPC) is an uncommon primary lung tumor with a low incidence and aggressive biological characteristics that can occur in young people and nonsmokers. Pleomorphic carcinoma (PC) has a worse prognosis than other non-small cell lung tumors. We describe a 45-year-old man who complained of having a dry cough for a month. A well-defined mass in the anterior section of the left lower lobe was identified by chest high-resolution computed tomography (HRCT), and a positron emission tomography (PET) scan confirmed a left lobulated tumor with fluorodeoxyglucose (FDG) uptake in the left mediastinal lymph nodes. An endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) guided biopsy of the tumor was performed and sent for histopathological analysis, which identified pleomorphic squamous cells and giant cells. Positive IHC markers included P63, TTF1, pancytokeratin, Vimentin. Patient was diagnosed with stage IIIa (T3N2M0) pleomorphic carcinoma of the lung. Due to the tumor's advanced stage, the patient received chemotherapy and radiation therapy.

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Author Biography

Vijaya Tourani, Department of Pathology, Care Hospitals, Hyderabad, Telangana, India

Pathologist

References

Chang YL, Lee YC, Shih JY, Wu CT. Pulmonary pleomorphic (spindle) cell carcinoma: peculiar clinicopathologic manifestations different from ordinary non-small cell carcinoma. Lung Cancer. 2001;34(1):91-7.

Brambilla E, Travis WD, Colby TV, Corrin B, Shimosato Y. The new World Health Organization classification of lung tumours. Eur Respir J. 2001;18(6):1059-68.

Beasley MB, Brambilla E, Travis WD. The 2004 World Health Organization classification of lung tumors. Semin Roentgenol. 2005;40(2):90-7.

Butnor KJ, Roden AC, Tazelaar, HD WJ. Thoracic Tumours. WHO Classification of Tumours Editorial Board. 2021.

Fishback NF, Travis WD, Moran CA, Guinee DG, McCarthy WF, Koss MN. Pleomorphic (spindle/giant cell) carcinoma of the lung. A clinicopathologic correlation of 78 cases. Cancer. 1994;73(12):2936-45.

Rossi G, Cavazza A, Sturm N, Migaldi M, Facciolongo N, Longo L, et al. Pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements: a clinicopathologic and immunohistochemical study of 75 cases. Am J Surg Pathol. 2003;27(3):311-24.

Yamamoto S, Hamatake D, Ueno T, Higuchi T, Hiratsuka M, Shiraishi T, et al. Clinicopathological investigation of pulmonary pleomorphic carcinoma. Eur J Cardiothorac Surg. 2007;32(6):873-6.

Chen Z, Liu J, Min L. Clinicopathological characteristics, survival outcomes and prognostic factors in pleomorphic carcinoma: a SEER population-based study. BMC Pulm Med. 2022;22(1):116.

Kaira K, Horie Y, Ayabe E, Murakami H, Takahashi T, Tsuya A, et al. Pulmonary pleomorphic carcinoma: a clinicopathological study including EGFR mutation analysis. J Thorac Oncol. 2010;5(4):460-5.

Kim TH, Kim SJ, Ryu YH, Lee HJ, Goo JM, Im JG, et al. Pleomorphic carcinoma of lung: comparison of CT features and pathologic findings. Radiology. 2004;232(2):554-9.

Ji C, Zhong C, Fang W, Zhao H. Surgical treatment for pulmonary pleomorphic carcinoma: A retrospective study of 60 patients. Thorac Cancer. 2014;5(3):250-4.

Chen F, Sonobe M, Sato T, Sakai H, Huang CL, Bando T, et al. Clinicopathological characteristics of surgically resected pulmonary pleomorphic carcinoma. Eur J Cardiothorac Surg. 2012;41(5):1037-42.

Butts CA, Ding K, Seymour L, Twumasi-Ankrah P, Graham B, Gandara D, et al. Randomized phase III trial of vinorelbine plus cisplatin compared with observation in completely resected stage IB and II non-small-cell lung cancer: updated survival analysis of JBR-10. J Clin Oncol. 2010;28(1):29-34.

Douillard JY, Rosell R, De Lena M, Carpagnano F, Ramlau R, Gonzáles-Larriba JL, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol. 2006;7(9):719-27.

Bae HM, Min HS, Lee SH, Kim DW, Chung DH, Lee JS, et al. Palliative chemotherapy for pulmonary pleomorphic carcinoma. Lung Cancer. 2007;58(1):112-5.

Okuda K, Oda R, Suzuki A, Sakane T, Kawano O, Haneda H, et al. Clinicopathological factors influenced the prognosis of surgically resected pulmonary pleomorphic carcinoma. J Thorac Dis. 2017;9(5):1295-302.

Lee S, Kim Y, Sun JM, Choi YL, Kim JG, Shim YM, et al. Molecular profiles of EGFR, K-ras, c-met, and FGFR in pulmonary pleomorphic carcinoma, a rare lung malignancy. J Cancer Res Clin Oncol. 2011;137(8):1203-11.

Amemiya R, Miyoshi T, Aokage K, Suzuki J, Hoshino H, Udagawa H, et al. Prognostic impact of the tumor immune microenvironment in pulmonary pleomorphic carcinoma. Lung Cancer. 2021;153:56-65.