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Okada K, Kita S, Yamanouchi H, Nakao S, Matsuda Y, Kusuno Y, Nomura K, Yabe T, Hayashi N, Fujimoto K, Furuichi K. Autopsy findings in a rare case of pleomorphic carcinoma in a patient on dialysis. Clin Case Rep 2024; 12:e9057. [PMID: 38868109 PMCID: PMC11166545 DOI: 10.1002/ccr3.9057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/22/2024] [Accepted: 05/25/2024] [Indexed: 06/14/2024] Open
Abstract
Pleomorphic lung cancer is a very rare type of cancer and very few cases have been reported in the literature. We present a case of pleomorphic lung cancer in a patient with history of IgA nephropathy on hemodialysis.
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Affiliation(s)
- Keiichiro Okada
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
| | - Serina Kita
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
| | - Hirotaka Yamanouchi
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
- Department of NephrologyAsanogawa General HospitalIshikawaJapan
| | - Shinichiro Nakao
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
| | - Yuto Matsuda
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
- Division of Internal Medicine, Keiju Medical CenterIshikawaJapan
| | - Yui Kusuno
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
- Department of NephrologyAsanogawa General HospitalIshikawaJapan
| | - Kazutoshi Nomura
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
- Department of NephrologyAsanogawa General HospitalIshikawaJapan
| | - Tomohisa Yabe
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
| | - Norifumi Hayashi
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
| | - Keiji Fujimoto
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
| | - Kengo Furuichi
- Department of NephrologyKanazawa Medical University School of MedicineIshikawaJapan
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2
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Castelluccia A, Sardaro A, Niccoli Asabella A, Pisani AR, Rubini D, Portaluri M, Tramacere F. Durable complete response to PET-CT driven stereotactic radiation therapy plus pembrolizumab for pleomorphic Pancoast cancer: Case report and literature review. Clin Case Rep 2024; 12:e8633. [PMID: 38585585 PMCID: PMC10996042 DOI: 10.1002/ccr3.8633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
PET-driven SBRT plus pembrolizumab as first-line therapy against pleomorphic Pancoast cancer appears beneficial, probably due to high equivalent doses of SBRT on photopenic necrotic core and synergic immune system stimulation of immunoradiotherapy.
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Affiliation(s)
| | - Angela Sardaro
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of MedicineUniversity of Bari “Aldo Moro”BariItaly
| | - Artor Niccoli Asabella
- Section of Nuclear Medicine, Interdisciplinary Department of MedicineUniversity of Bari Aldo MoroBariItaly
| | - Antonio Rosario Pisani
- Section of Nuclear Medicine, Interdisciplinary Department of MedicineUniversity of Bari Aldo MoroBariItaly
| | - Dino Rubini
- Department of Precision MedicineUniversità degli Studi della Campania Luigi VanvitelliNapoliCampaniaItaly
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3
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Hayashi F, Akagi K, Taniguchi H, Matsutake T, Kawahara H, Sekine I, Gyotoku H, Takemoto S, Soda H, Ashizawa K, Mukae H. TIM-3 expression induces resistance to PD-1 inhibitor in G-CSF-producing lung spindle cell carcinoma: A case report. Thorac Cancer 2023; 14:3556-3560. [PMID: 37926435 PMCID: PMC10733156 DOI: 10.1111/1759-7714.15149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
Lung spindle cell carcinoma is an aggressive subtype of pleomorphic lung cancer resistant to cytotoxic chemotherapy. Programmed cell death-1 (PD-1) inhibitors have been reported to have clinical effects in patients with spindle cell carcinoma; however, the resistance mechanism to PD-1 inhibitors is yet to be fully elucidated. Herein, we report the case of an 88-year-old man with G-CSF-producing spindle cell carcinoma who acquired resistance to PD-1/PD-ligand 1 (L1) inhibitor in an early setting after a remarkable response. A histopathological review of the resistant specimen revealed a low count of CD8+ T cells and a predominant presence of M2 and TIM-3+ macrophages, indicating the presence of an immunosuppressive microenvironment. Our findings suggest a novel resistance mechanism to PD-1/PD-L1 inhibitors in G-CSF-producing spindle cell carcinoma.
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Affiliation(s)
- Fumiko Hayashi
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
| | - Kazumasa Akagi
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Clinical Oncology CenterNagasaki University HospitalNagasakiJapan
| | - Hirokazu Taniguchi
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Clinical Oncology CenterNagasaki University HospitalNagasakiJapan
| | | | - Hiromi Kawahara
- Department of Internal MedicineKouseikai HospitalNagasakiJapan
| | - Ichiro Sekine
- Department of PathologyKouseikai HospitalNagasakiJapan
| | - Hiroshi Gyotoku
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Shinnosuke Takemoto
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hiroshi Soda
- Department of Respiratory MedicineSasebo City General HospitalSaseboJapan
| | - Kazuto Ashizawa
- Clinical Oncology CenterNagasaki University HospitalNagasakiJapan
- Department of Clinical OncologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hiroshi Mukae
- Department of Respiratory MedicineNagasaki University HospitalNagasakiJapan
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
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4
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Poston LM, Bassiri A, Jiang B, Boutros C, Sinopoli J, Tapias Vargas L, Linden PA, Towe CW. Is Sarcomatoid Lung Cancer Associated With Inferior Overall Survival? A National Cancer Database Analysis. J Surg Res 2023; 291:380-387. [PMID: 37516045 DOI: 10.1016/j.jss.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Sarcomatoid lung cancer has mainly been described in case series and single institution reviews. Although often associated with a poor prognosis, the overall survival compared to other forms of nonsmall cell lung cancer (NSCLC) is unknown. We hypothesize that sarcomatoid lung cancers have worse overall survival relative to other forms of NSCLC. MATERIALS AND METHODS In this retrospective cohort study, we identified adult patients with nonmetastatic NSCLC from 2004 to 2018 in the National Cancer Database. Patients were categorized by histology as sarcomatoid, adenocarcinoma, or squamous cell carcinoma. We compared clinical and demographic characteristics between the groups. The primary outcome of overall survival was analyzed using Kaplan-Meier analysis. Multivariable Cox analysis was used to analyze factors associated with overall survival in sarcomatoid patients undergoing surgery. RESULTS Among 1,259,109 patients with lung cancer, there were 5223 (0.4%) sarcomatoid cancers. Sarcomatoid patients were more likely to be male, of Hispanic ethnicity, have fewer comorbidities, and receive treatment at an academic program. Despite higher cT- and M-stages, patients with sarcomatoid cancer were more likely to undergo surgical resection in multivariate analysis (odds ratio = 1.8 [confidence interval 1.60-2.11]; P < 0.001). Among nonmetastatic patients, overall survival was lower for sarcomatoid cancer relative to other histologies in Kaplan-Meier analysis (median survival sarcomatoid 17.6 mo versus nonsarcomatoid 31.5 mo, P < 0.001). CONCLUSIONS This National Cancer Database study confirms the findings of smaller studies that sarcomatoid cancer is associated with inferior overall survival compared to other NSCLCs. Given the inferior prognosis, further studies regarding optimal staging practices are appropriate.
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Affiliation(s)
- Lauren M Poston
- Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Aria Bassiri
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Boxiang Jiang
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christina Boutros
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Iwamura M, Nishimori M, Iwasa H, Otani M, Nakaji K, Nitta N, Miyatake K, Yoshimatsu R, Yamanishi T, Matsumoto T, Iguchi M, Okada H, Yamagami T. A case of pulmonary pleomorphic carcinoma associated with cystic airspace. Radiol Case Rep 2023; 18:2692-2696. [PMID: 37273726 PMCID: PMC10238256 DOI: 10.1016/j.radcr.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Lung cancer associated with a cystic airspace is frequently misdiagnosed or overlooked. Adenocarcinoma, followed by squamous cell carcinoma, is the most typical histologic type of lung cancer connected to a cystic airspace. Here we present the rare case of lung pleomorphic carcinoma associated with a cystic airspace. We encountered a 74-year-old Japanese man diagnosed by computed tomography (CT) as having a nodule outside a cystic airspace in the lung. Several previous CT images showed that the cystic airspace preceded the nodule. Postsurgery, pathology indicated a diagnosis of pleomorphic carcinoma. Since pulmonary pleomorphic carcinomas pursue an aggressive clinical course, their early detection may contribute to an improved prognosis. Our case demonstrated that pleomorphic carcinoma can arise with cystic airspaces. For early diagnosis of those aggressive lung cancers, chest physicians should carefully examine the walls of cystic airspaces on CT.
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Affiliation(s)
- Mamiko Iwamura
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Miki Nishimori
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hitomi Iwasa
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michimi Otani
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kosuke Nakaji
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Noriko Nitta
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kana Miyatake
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Mitsuko Iguchi
- Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Moran CA. Primary Pulmonary Carcinomas with Spindle and/or Giant Cell Features: A Review with Emphasis in Classification and Pitfalls in Diagnosis. Diagnostics (Basel) 2023; 13:2477. [PMID: 37568840 PMCID: PMC10417730 DOI: 10.3390/diagnostics13152477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
Primary carcinomas of the lung are vastly represented by the conventional types of adenocarcinomas or squamous cell carcinomas. However, there are other types of non-small cell carcinomas that although uncommon represent a meaningful group that often pose a problem not only in diagnosis but also in classification. Spindle cell and/or giant cell carcinomas, although uncommon represent an important group of primary lung carcinomas. Important to highlight is that current criteria are rather ambiguous and likely not up to date, which renders the classification of these tumors somewhat more obscure. In addition, with the daily use of immunohistochemical stains, the classification of these tumors may also pose a different problem in the proper allocation of these tumors. Proper classification is highly important in the selection process that takes place using such material for molecular analysis. The current molecular characteristics of these tumors are limited and lack more in-depth studies and analyses that can provide specific targets for the treatment of patients with these tumors. The current review attempts to highlight the shortcomings in the current classification and definitions of these neoplasms as well as the more current view regarding these tumors when the use of immunohistochemical stains is employed.
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Affiliation(s)
- Cesar A Moran
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
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7
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Wang F, Yu X, Han Y, Gong C, Yan D, Yang L, Li J, Liu S. Chemotherapy for advanced pulmonary sarcomatoid carcinoma: a population-based propensity score matching study. BMC Pulm Med 2023; 23:262. [PMID: 37454075 DOI: 10.1186/s12890-023-02541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Pulmonary sarcomatoid carcinoma (PSC) is a rare histological type of non-small cell lung cancer (NSCLC). There are no specific treatment guidelines for PSC. For advanced PSC (stage II-IV), the role of chemotherapy is still controversial. The purpose of this study was to investigate the effect of chemotherapy on the prognosis of advanced PSC. METHODS A total of 960 patients with advanced PSC from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2019 were enrolled in this study. To investigate the prognostic factors, the Cox proportional hazard regression model was conducted. A total of 642 cases were obtained after propensity score matching (PSM). The Kaplan‒Meier method was applied to compare overall survival (OS) and cancer-specific survival (CSS). RESULTS For all 960 cases included in this study, the Cox proportional hazard model was applied for prognostic analysis. Univariate and multivariate analyses showed that stage, T stage, N stage, M stage, surgery, and chemotherapy were prognostic factors for OS and CSS (P < 0.05). A total of 642 cases were obtained after PSM, with no significant difference between the two groups for all variables. Kaplan‒Meier curves indicated that for OS and CSS, the prognosis was significantly better in the chemotherapy group than in the no-chemotherapy group. CONCLUSIONS For advanced PSC, chemotherapy can significantly improve the OS and CSS of patients. Chemotherapy should be an important part of PSC treatment.
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Affiliation(s)
- Feng Wang
- Beijing Chest Hospital, Capital Medical University, Beijing, 101125, China
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101125, China
| | - Xiangyang Yu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yi Han
- Beijing Chest Hospital, Capital Medical University, Beijing, 101125, China
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101125, China
| | - Changfan Gong
- Beijing Chest Hospital, Capital Medical University, Beijing, 101125, China
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101125, China
| | - Dongjie Yan
- Beijing Chest Hospital, Capital Medical University, Beijing, 101125, China
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101125, China
| | - Lei Yang
- Beijing Chest Hospital, Capital Medical University, Beijing, 101125, China
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101125, China
| | - Jie Li
- Beijing Chest Hospital, Capital Medical University, Beijing, 101125, China.
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101125, China.
| | - Shuku Liu
- Beijing Chest Hospital, Capital Medical University, Beijing, 101125, China.
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101125, China.
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Alejo AL, Patel RA, Pandya KK, Bodrya K, Goldstein L, Hemrock L. Asbestos Exposure and Development of Pulmonary Pleomorphic Carcinoma in a Non-smoker: A Rare Non-small Cell Lung Cancer. Cureus 2023; 15:e37860. [PMID: 37213984 PMCID: PMC10199346 DOI: 10.7759/cureus.37860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Pulmonary pleomorphic carcinoma (PPC) is a subtype of non-small cell lung cancer that is extremely rare and carries a poor prognosis due to its inadequate response to treatment. Patients that present with PPC often exhibit similar symptoms of other malignancies of the lung, making it hard for clinicians to distinguish between each type. However, cytology and gene mutation testing are two approaches that can aid physicians in an accurate and definitive diagnosis. We present a case of an 88-year-old male patient with a diagnosis of pulmonary pleomorphic carcinoma after experiencing recurrent sanguineous pleural effusions. The patient had no smoking history but did have a history of asbestos exposure and pulmonary fibrosis. The patient underwent thoracotomy with pleurodesis and analysis of the surgical pleural biopsy specimen stained positive for markers indicative of PPC. The pathology report was also consistent with the associated cell morphology. Lung cancer is the leading cause of mortality due to cancer in the United States, and exposure to certain substances contributes to the development of these poorly treatable lung malignancies. Smoking and asbestos exposure are well known to act synergistically with each other as risk factors in developing these lung malignancies. In addition to clinical suspicion, screening for these risk factors with laboratory values and imaging is important to diagnose these rare cases of lung malignancies.
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Affiliation(s)
- Andrew L Alejo
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Riya A Patel
- Internal Medicine, Trumbull Regional Medical Center, Warren, USA
| | | | - Krishna Bodrya
- Internal Medicine, Trumbull Regional Medical Center, Warren, USA
| | | | - Lori Hemrock
- Internal Medicine, Trumbull Regional Medical Center, Warren, USA
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Dündar Çağlayan CN, Engin MN, Boz A. A Rare Case and Atypical Metastatic Regions, Pulmonary Giant Cell Carcinoma. Mol Imaging Radionucl Ther 2023; 32:74-76. [PMID: 36820010 PMCID: PMC9950673 DOI: 10.4274/mirt.galenos.2022.50133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Sixty two years old man referred to our clinic due to suspicion of thymic mass. The hypermetabolic nodular lesion in the right lung upper lobe was seen in 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in addition to the mass in the anterior mediastinum which was found to without malignancy. The patient underwent wedge resection and final diagnosis was pulmonary giant cell carcinoma. In follow-up 18F-FDG PET/CT multiple lesions with pathological activity were observed in the cerebrum, right postauricular region, bilateral adrenal, stomach, pancreas, pelvic soft tissue, mesenteric, left femur and bilateral lung parenchyma 6 months after. The pathology results of the right frontal, pelvic mass and the postauricular region were metastasis.
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Affiliation(s)
- Ceyda Nur Dündar Çağlayan
- Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey,* Address for Correspondence: Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey Phone: +90 242 227 64 85 E-mail:
| | - Müge Nur Engin
- Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey
| | - Adil Boz
- Akdeniz University Hospital, Department of Nuclear Medicine, Antalya, Turkey
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10
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Vorobjev IA, Bekbayev S, Temirgaliyev A, Tlegenova M, Barteneva NS. Imaging Flow Cytometry of Multi-Nuclearity. Methods Mol Biol 2023; 2635:87-101. [PMID: 37074658 DOI: 10.1007/978-1-0716-3020-4_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Multi-nuclearity is a common feature for cells in different cancers. Also, analysis of multi-nuclearity in cultured cells is widely used for evaluating the toxicity of different drugs. Multi-nuclear cells in cancer and under drug treatments form from aberrations in cell division and/or cytokinesis. These cells are a hallmark of cancer progression, and the abundance of multi-nucleated cells often correlates with poor prognosis.The use of standard bright field or fluorescent microscopy to analyze multi-nuclearity at the quantitative level is laborious and can suffer from user bias. Automated slide-scanning microscopy can eliminate scorer bias and improve data collection. However, this method has limitations, such as insufficient visibility of multiple nuclei in the cells attached to the substrate at low magnification.Since quantification of multi-nuclear cells using microscopic methods might be difficult, imaging flow cytometry (IFC) is a method of choice for this. We describe the experimental protocol for the preparation of the samples of multi-nucleated cells from the attached cultures and the algorithm for the analysis of these cells by IFC. Images of multi-nucleated cells obtained after mitotic arrest induced by taxol, as well as cells obtained after cytokinesis blockade by cytochalasin D treatment, can be acquired at a maximal resolution of IFC. We suggest two algorithms for the discrimination of single-nucleus and multi-nucleated cells. The advantages and disadvantages of IFC analysis of multi-nuclear cells in comparison with microscopy are discussed.
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Affiliation(s)
- Ivan A Vorobjev
- School of Sciences and Humanities, Nazarbayev University, Astana, Kazakhstan.
- National Laboratory Astana, Nazarbayev University, Astana, Kazakhstan.
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russian Federation.
- Biological Faculty, Lomonosov Moscow State University, Moscow, Russian Federation.
| | - Sultan Bekbayev
- School of Sciences and Humanities, Nazarbayev University, Astana, Kazakhstan
| | - Adil Temirgaliyev
- School of Sciences and Humanities, Nazarbayev University, Astana, Kazakhstan
| | - Madina Tlegenova
- National Laboratory Astana, Nazarbayev University, Astana, Kazakhstan
| | - Natasha S Barteneva
- School of Sciences and Humanities, Nazarbayev University, Astana, Kazakhstan
- Brigham Women's Hospital, Harvard University, Boston, MA, USA
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Kajita T, Miyashita H, Kitamura J, Kouketsu A, Kumamoto H, Takahashi T. Pulmonary pleomorphic carcinoma metastasizing to the anterior mandibular gingiva: A case report and literature review. Int J Surg Case Rep 2022; 98:107499. [PMID: 36037640 PMCID: PMC9433676 DOI: 10.1016/j.ijscr.2022.107499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Pulmonary pleomorphic carcinoma (PPC) is a rare subtype of non-small cell lung cancer. No standard therapy has been established for advanced disease, which results in poor prognosis. Some cases of PPC metastasizing to mandibular gingiva have been reported, and the involved site in these reports is all unilateral mandible. Case presentation We report a case of PPC metastasizing to the anterior mandibular gingiva in a 68-year-old man. The patient was referred to our hospital with tumor bleeding and difficulty with intake. One month before, he had been diagnosed as PPC. The size of oral tumor was 28 × 25 mm, and we performed surgical resection. Although there was no recurrence of oral lesion, he died of systemic metastases after 3 months since the surgery. Clinical discussion The prognosis of patients with metastatic tumor in oral region is poor. Radical treatment for oral lesion is often difficult due to the existence of other metastasis or the refractory, in particular cases with high grade malignancies such as PPC. On the other hand, because of the development of cancer treatment and the arrival of super-aging society, the number of patients with metastatic tumor in oral region has been expected to increase in future. Conclusion PPC metastasizing to the gingiva of mandibular symphysis is extremely rare. If there are possibilities to improve the prognosis or quality of life, radical or palliative treatment for metastatic tumor in oral region should be performed. Metastases to oral cavity from Pulmonary pleomorphic carcinoma The clinical symptoms of metastatic tumor in oral cavity The improvement of patient's QOL
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Affiliation(s)
- Tomonari Kajita
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Hitoshi Miyashita
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Jun Kitamura
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Atsumu Kouketsu
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Hiroyuki Kumamoto
- Division of Oral Pathology, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
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Morimoto T, Yamasaki K, Shingu T, Sato T, Uryu T, Jotatsu T, Kato K, Kawabata H, Nishida C, Yatera K. Autopsy case of a patient with rapidly progressive combined small-cell lung carcinoma with spindle-shaped cell tumor. Thorac Cancer 2022; 13:2279-2282. [PMID: 35762505 PMCID: PMC9346181 DOI: 10.1111/1759-7714.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
A 69-year-old Japanese man visited our hospital because of worsening shortness of breath. His chest computed tomography (CT) showed a giant left lung mass with a massive left pleural effusion. He could not be treated with chemotherapy and eventually died from a rapidly progressive tumor. He was diagnosed with combined small cell lung carcinoma (C-SCLC) with spindle-shaped cell tumor at autopsy. C-SCLC is characterized by pathologically concurrent SCLC and adenocarcinoma or squamous cell carcinoma, or rarely, spindle-shaped cell tumor. The clinical course of C-SCLC with spindle-shaped cell tumor has not previously been determined. Our patient's tumor increased by 2.59-fold in 20 days. The combination of C-SCLC with spindle-shaped cell tumor suggested rapid progression and a poor prognosis.
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Affiliation(s)
- Toshiki Morimoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Tatsuya Shingu
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Tomoki Sato
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Takumu Uryu
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Takanobu Jotatsu
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Kaori Kato
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Hiroki Kawabata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Chinatsu Nishida
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
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13
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Tomiyasu S, Kabata H, Emoto K, Azekawa S, Maeda C, Masai K, Yasuda H, Fukunaga K. A 70-Year-Old Woman With Long-Term Nonresolving Pneumonia. Chest 2022; 161:e219-e223. [DOI: 10.1016/j.chest.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/08/2021] [Accepted: 10/16/2021] [Indexed: 10/18/2022] Open
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14
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Shishido Y, Aoyama A, Hara S, Sato Y, Tomii K, Hamakawa H, Takahashi Y. Ringed fluorodeoxyglucose uptake predicted poor prognosis after resection of pulmonary pleomorphic carcinoma. J Cardiothorac Surg 2022; 17:47. [PMID: 35313902 PMCID: PMC8935789 DOI: 10.1186/s13019-022-01799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary pleomorphic carcinoma (PPC) is a relatively rare and poorly differentiated non-small cell carcinoma. This study aimed to investigate the clinicopathological features including programmed cell death ligand 1 (PD-L1) expression status in patients with PPC who underwent curative resection. Methods We retrospectively studied 29 consecutive patients who had undergone anatomical lung resections for PPC. Perioperative and pathological variables, including radiological findings, were investigated to define prognostic factors. Results Overall survival (OS) rates were 71.8% at 1 year and 60.0% at 5 years. Disease-free survival (DFS) rates were 54.8% at 1 year and 43.6% at 5 years. Univariate analysis revealed that ringed fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) (p = 0.003), a cavity in the tumor on CT (p = 0.004), and tumor size (> 40 mm) (p = 0.014) were poor prognostic factors for OS. Regarding DFS, ringed FDG uptake (p = 0.002), a cavity on CT (p < 0.001), tumor size (p = 0.007), and pleural invasion (p = 0.014) were poor prognostic factors. PD-L1 expression was not a prognostic factor. Conclusion This study showed for the first time that ringed FDG uptake on PET/CT is a poor prognostic factor of PPC. PD-L1 expression status was not related to the prognosis. Trial registration The study was approved by the Kobe City Medical Center General Hospital’s ethics board (No. 20112) on August 20, 2020.
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15
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Sako M, Nokihara H, Kondo K, Mitsuhashi A, Ozaki R, Yabuki Y, Abe A, Yoneda H, Ogino H, Otsuka K, Uehara H, Nishioka Y. A case of pulmonary pleomorphic carcinoma with preexisting interstitial pneumonia successfully treated with pembrolizumab. Thorac Cancer 2021; 13:129-132. [PMID: 34859591 PMCID: PMC8720630 DOI: 10.1111/1759-7714.14243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/26/2022] Open
Abstract
Pulmonary pleomorphic carcinoma is often refractory to chemotherapy and follows an aggressive clinical course. Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced lung cancer, and a few cases with pleomorphic carcinoma have been reported to show tumor shrinkage after therapy with ICIs. When treating patients with ICIs, patient selection is essential, and monitoring and management of immune‐related adverse events, including pneumonitis, are needed. We herein report a case of pulmonary pleomorphic carcinoma with preexisting interstitial pneumonia treated with pembrolizumab, antiprogrammed cell death 1 antibody. Our report highlights important considerations necessary when treating advanced pleomorphic carcinoma patients complicated with interstitial pneumonia. We also review the literature regarding the use of ICIs in such patients.
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Affiliation(s)
- Masahiro Sako
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Department of Community Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Hiroshi Nokihara
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kensuke Kondo
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Department of Community Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Atsushi Mitsuhashi
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryohiko Ozaki
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yohei Yabuki
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Akane Abe
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hiroto Yoneda
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kenji Otsuka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hisanori Uehara
- Division of Pathology, Tokushima University Hospital, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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16
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Dinis de Sousa M, Barata M, Miranda AR, Sequeira P, Oliveira A, Xavier L, Mansinho H. Beta-HCG secretion by a pulmonary pleomorphic carcinoma: A case report. Respir Med Case Rep 2021; 34:101528. [PMID: 34754749 PMCID: PMC8556653 DOI: 10.1016/j.rmcr.2021.101528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/06/2021] [Accepted: 10/19/2021] [Indexed: 11/22/2022] Open
Abstract
Ectopic secretion of beta-subunit of human chorionic gonadotropin (β-HCG) in pulmonary pleomorphic carcinoma is remarkably rare. Such unusual ectopic hormone production by lung cancer may be initially misinterpreted as extragonadal choriocarcinoma or germ cell tumor. We report a 56-year-old postmenopausal female, smoker, who presented a 5-month history of progressive dyspnea, dry paroxysmal cough, and significant weight loss. She was referred by a local hospital with the preliminary diagnosis of gestational trophoblastic neoplasia due to a rapidly growing thoracic tumor with persistently elevated serum β-HCG. Computed tomography of the chest showed a lung mass in the right upper lobe associated with homolateral pleural effusion. Positron emission tomography showed pathological 2-[18F]FDG uptake at the mass lesion. Biopsies were performed. Histological examination described pleomorphic carcinoma with positive immunostaining for β-HCG. The serum levels of β-HCG were also elevated indicating ectopic secretion. The patient had rapid clinical deterioration and deceased before chemotherapy initiation. Only a few cases of paraneoplastic β-HCG secretion have been reported in the literature. Previous studies suggested that the ability to secrete β-hCG in tumors may correlate to some extent to chemoresistance; thus, it might be useful as a prognosis marker.
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Affiliation(s)
- Magno Dinis de Sousa
- Heamato-Oncology Department, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Margarida Barata
- Pulmonology Department, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Ana Raquel Miranda
- Heamato-Oncology Department, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Pedro Sequeira
- Anatomic Pathology Department, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Ana Oliveira
- Anatomic Pathology Department, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Luísa Xavier
- Heamato-Oncology Department, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Hélder Mansinho
- Heamato-Oncology Department, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, 2805-267, Almada, Portugal
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17
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Agaimy A. Pleomorphic (giant cell) carcinoma revisited: A historical perspective and conceptual reappraisal. Semin Diagn Pathol 2021; 38:187-192. [PMID: 34583859 DOI: 10.1053/j.semdp.2021.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/11/2022]
Abstract
The term pleomorphic "giant cell" carcinoma was coined by Sommers and Meissner in 1954 for a pancreatic carcinoma variant showing a "sarcoma-like transformation" and characterized by an admixture of undifferentiated cells with striking variation in size and shape. Based on the predominant cell type, four patterns were recognized: spindle cell (sarcomatoid), pleomorphic "giant cell", osteoclastic giant cell-rich, and anaplastic round cell. These four basic patterns frequently coexisted within same tumor, albeit to a significantly variable extent. Follow-up series further characterized the entity, expanded its topographic distribution to include almost all organ systems, and illustrated its morphological and phenotypic homology among different organs. Although resemblance of the neoplastic cells to rhabdomyoblasts was already pointed out by Stout in 1958, the term "rhabdoid" (introduced in 1978 for specific kidney tumors) was not used for carcinomas until 1993. Review of the old and recent literature indicates pleomorphic "giant cell" carcinoma is not an entity but a morphological pattern in the spectrum of undifferentiated (anaplastic) and sarcomatoid carcinoma that can originate in any organ, either in a pure form or as a dedifferentiated carcinoma component. These tumors fall into two major categories: a monomorphic (variable admixture of small or larger "gemistocyte-like" rhabdoid cells and epithelioid cells) and a pleomorphic (bizarre large polygonal, spindled, or multinucleated malignant cells) subtype. The few available genetic studies suggest close association of the monomorphic type with SWI/SNF pathway defects, while bizarre-looking pleomorphic tumors usually harbor complex and heterogeneous genetic alterations. Most tumors dominated by the pleomorphic "giant cell" pattern are extremely aggressive, resulting in death, soon after diagnosis, irrespective of treatment modalities. This review gives an historical account on the evolution of the pleomorphic "giant cell" carcinoma concept with special reference to their relationship to SWI/SNF complex alterations.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital, Erlangen, Germany.
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18
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Tormen F, Banchelli F, Masciale V, Maiorana A, Morandi U, Aramini B. The importance of medical treatment before surgery in pleomorphic carcinoma of the lung: A case series study. Int J Surg Case Rep 2021; 86:106275. [PMID: 34392016 PMCID: PMC8365429 DOI: 10.1016/j.ijscr.2021.106275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Pleomorphic carcinoma of the lung is a rare malignant epithelial tumor. Due to its rarity, its clinicopathological characteristics are not clear, and there is no defined therapeutic path for this type of tumor. Case presentation We retrospectively analyzed the medical and pathological reports of 8 patients who underwent surgical resection for pleomorphic carcinoma between 2007 and 2010. Clinical discussion Eight patients were analyzed (7 males and 1 female, mean age 60). All patients underwent CT scans, and the average diameter of the nodules was 56 mm. Four patients were also investigated with FDG-PET with hypermetabolic activity in all four cases. In four patients, the carcinomatous component was adenocarcinoma (all with sarcomatoid component of spindle cell and giant cell carcinoma), although in two patients, it was squamous cell carcinoma (one with spindle cell and one with giant cell). In the two remaining patients, one showed a non-small cell carcinoma with giant cell carcinoma, and the other was a non-small cell carcinoma and squamous cell carcinoma with spindle and giant cell carcinoma. All cases were treated with surgical resection. Only two patients underwent neoadjuvant chemotherapy. At the time of data analysis, only one patient treated with neoadjuvant chemotherapy was alive. Conclusion The prognosis for these patients with a diagnosis of pleomorphic carcinoma undergoing surgery is generally better than those not treated with surgical resection, however the survival remains poor. Although with low number of patients, our research would suggest to consider neoadjuvant chemotherapy an appropriate approach for improving the outcomes before surgery. Pleomorphic carcinoma of the lung Rare malignant epithelial tumor Clinicopathological characteristics unclear Not defined therapeutic path Neoadiuvant chemotherapy improves the prognosis.
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Affiliation(s)
- Francesco Tormen
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Banchelli
- Center of Statistic, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Italy
| | - Valentina Masciale
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Antonino Maiorana
- Institute of Pathology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Italy.
| | - Uliano Morandi
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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19
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Second primary pleomorphic carcinoma arising from the pneumonectomy cavity of non-small cell lung cancer: A case report. Respir Med Case Rep 2021; 32:101373. [PMID: 33732613 PMCID: PMC7941158 DOI: 10.1016/j.rmcr.2021.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022] Open
Abstract
Here, we report a thirteen years’ survivor of initial primary lung cancer, who successfully diagnosed with second primary lung cancer(SPLC). It was arising from the pneumonectomy cavity of a non-small cell lung cancer(NSCLC). Few cases of SPLC associated with the post-pneumonectomy cavity have been reported in the literature. The histologic results of SPLC was metastatic pleomorphic carcinoma. It is a rare type of lung cancer; which incidence has been reported to range from 0.1% to 0.4% among all lung cancers. Based on regular follow-up with chest computed tomography(CT) and an understanding of post-pneumonectomy changes, the second primary pleomorphic carcinoma was correctly diagnosed and appropriately treated.
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20
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Terra SBSP, Roden AC, Aubry MC, Yi ESJ, Boland JM. Utility of Immunohistochemistry for MUC4 and GATA3 to Aid in the Distinction of Pleural Sarcomatoid Mesothelioma From Pulmonary Sarcomatoid Carcinoma. Arch Pathol Lab Med 2021; 145:208-213. [PMID: 33501493 DOI: 10.5858/arpa.2019-0647-oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Distinguishing pulmonary sarcomatoid carcinoma from pleural sarcomatoid mesothelioma is challenging because of overlapping histology, immunophenotype, and clinical features. Reliable immunohistochemical markers to aid in this distinction would be very valuable. Recent studies have proposed that MUC4 expression is common in sarcomatoid carcinoma but not in sarcomatoid mesothelioma, with the converse pattern reported for GATA3. OBJECTIVE.— To further explore the utility of MUC4 and GATA3 in distinguishing pulmonary sarcomatoid carcinoma from sarcomatoid mesothelioma. DESIGN.— Well-characterized cases of sarcomatoid carcinoma (n = 32) and sarcomatoid mesothelioma (n = 64) were included. Diagnoses were confirmed by thoracic pathologists with incorporation of immunophenotype, clinical, and radiographic features. Whole-tissue sections were stained for GATA3 and MUC4. RESULTS.— Patients with sarcomatoid carcinoma and sarcomatoid mesothelioma had similar mean age and male predominance. GATA3 was positive in 63 of 64 sarcomatoid mesotheliomas (98%; 42 diffuse, 16 patchy, 5 focal), and 15 of 32 sarcomatoid carcinomas (47%; 3 diffuse, 8 patchy, 4 focal). MUC4 was positive in 2 of 64 sarcomatoid mesotheliomas (3%; 1 patchy, 1 focal), and in 12 of 32 sarcomatoid carcinomas (38%; 5 diffuse, 6 patchy, 1 focal). CONCLUSIONS.— Diffuse GATA3 expression favors sarcomatoid mesothelioma over sarcomatoid carcinoma, which rarely shows diffuse expression (sensitivity and specificity of diffuse staining 66% and 94%, respectively). Focal and patchy GATA3 expression is observed in both tumor types, and therefore is not helpful in this distinction. Sensitivity of MUC4 for sarcomatoid carcinoma was low in our cohort, positive in only 38% with frequent patchy staining, but it was quite specific.
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Affiliation(s)
- Simone B S P Terra
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Anja C Roden
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Marie Christine Aubry
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Eunhee S Joanne Yi
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer M Boland
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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21
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Ogawa D, Arahata M, Kuriyama M, Shinagawa S, Tomizawa G, Shimizu Y. Pulmonary Pleomorphic Carcinoma Mimicking Primary Sarcoma of the Neck: A Case Report and Literature Review. Clin Interv Aging 2021; 16:325-333. [PMID: 33654389 PMCID: PMC7914056 DOI: 10.2147/cia.s296875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
We describe our challenge in diagnosing an unusual and rapidly progressing case of pulmonary pleomorphic carcinoma (PPC)—a rare, poorly differentiated, or undifferentiated non-small-cell carcinoma that can metastasize locally or distantly and has a poor prognosis. Our patient was an elderly man with a one-month history of abdominal pain, anorexia, and weight loss, diagnosed with atrophic gastritis via endoscopy, and treated medically without improvement. A week later, this patient developed pain in the head, neck, and shoulder area, and further examination revealed a thickening of his left neck and shoulder, with no palpable lymph nodes. Computed tomography (CT) of the neck, chest, and abdomen led us to believe that we might be dealing with primary sarcoma of the neck since no lung mass was evident. Further investigation could not be performed because the patient’s status deteriorated rapidly. An autopsy revealed that soft tissue in the left neck and the mesentery was invaded by poorly differentiated polymorphic malignant cells, which were also seen in the lung lesion. Immunohistochemically, these malignant cells were all positive for AE1/AE3, CAM5.2, TTF-1, Napsin-A, and Vimentin. The cells were also positive for programmed death-ligand 1 staining with a low level of tumor proportion score (over 1%). The final diagnosis was PPC with metastases to soft tissues in the left neck and the mesentery. A review of previous case reports of PPC revealed that soft tissue is an uncommon site for metastasis, and that our CT findings were rather unusual. We hereby present our case and review of published case reports, with the hope that an awareness of the heterogeneous features of PPC could prompt timely biopsy and histological diagnosis.
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Affiliation(s)
- Daishi Ogawa
- Nanto Community Medical Support Unit, Toyama University Hospital, Toyama, Toyama, Japan.,Department of General Medicine, Nanto Municipal Hospital, Toyama, Toyama, Japan
| | - Masahisa Arahata
- Department of General Medicine, Nanto Municipal Hospital, Toyama, Toyama, Japan
| | - Masato Kuriyama
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan
| | - Shunji Shinagawa
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan
| | - Gakuto Tomizawa
- Department of Radiology, Nanto Municipal Hospital, Nanto, Toyama, Japan
| | - Yukihiro Shimizu
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan
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22
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Okauchi S, Sasatani Y, Shiozawa T, Yamada H, Miyazaki K, Takayashiki N, Satoh H. Combination of Pembrolizumab With Platinum-containing Chemotherapy for Pleomorphic Carcinoma of the Lung. In Vivo 2021; 34:1439-1443. [PMID: 32354943 DOI: 10.21873/invivo.11926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Pleomorphic carcinoma of the lung is a rare, highly malignant subtype of lung cancer, with a more aggressive clinical course compared with other types of non-small-cell lung cancer (NSCLC). Platinum-containing chemotherapy has been the standard therapy for patients with NSCLC and pembrolizumab is one of the novel and reliable agents for these patients. CASE REPORT We herein report the case of a 60-year-old man with advanced chemo-naïve pleomorphic carcinoma of the lung who was successfully treated with a combination of pembrolizumab with platinum-containing chemotherapy. CONCLUSION In the absence of definitive clinical trials, which are unlikely to be performed due to the rarity of this tumor, our case demonstrates the potential utility of the combination of pembrolizumab with platinum-containing chemotherapy. Our result also suggest that this combination of therapy may be key to the treatment of pleomorphic carcinoma of the lung.
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Affiliation(s)
- Shinichiro Okauchi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Yuika Sasatani
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Toshihiro Shiozawa
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyasu Yamada
- Division of Respiratory Medicine, Hitachinaka Medical Center, University of Tsukuba-Hitachinaka General Hospital, Hitachinaka, Japan
| | - Kunihiko Miyazaki
- Division of Respiratory Medicine, Ryugasaki Saiseikai General Hospital, Ryugasaki, Japan
| | - Norio Takayashiki
- Division of Pathology, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
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23
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Chuan TY, Mun WL, Siang WH. An 86-Year-Old Woman Presenting With 2 Weeks of Worsening Dyspnea and Cough. Chest 2021; 159:e103-e106. [PMID: 33563451 DOI: 10.1016/j.chest.2020.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022] Open
Abstract
CASE PRESENTATION An 86-year-old Singaporean Malay woman with no known respiratory condition presented with 2 weeks of progressively worsening dyspnea, cough, and pleuritic chest pain. There was a positive sick contact and recent long-distance travel to Norway. However, further history revealed her symptoms presented even prior to her overseas trip. Red flag symptoms of hemoptysis, loss of appetite/weight, and risk factors such as smoking/occupational exposure, and personal and familial history of cancer were absent.
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Affiliation(s)
- Tan Yong Chuan
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
| | - Wang Lai Mun
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Wong Hang Siang
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
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24
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Chen Y, Zhang H, Shi J, Wang T. A Partial Response of Pulmonary Pleomorphic Carcinoma to Camrelizumab (PD1 Monoclonal Antibody) Monotherapy: A Case Report. Onco Targets Ther 2020; 13:12471-12476. [PMID: 33299330 PMCID: PMC7721275 DOI: 10.2147/ott.s279004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
We report a case of a 68-year-old man diagnosed with pulmonary pleomorphic carcinoma who showed partial response after a single treatment with camrelizumab (PD1 monoclonal antibody). The patient's tumor was positive for programmed cell death ligand 1 (PD-L1) and progressed rapidly after a course of chemotherapy. Fortunately, the tumors dramatically shrank after one cycle of camrelizumab, an anti-programmed cell death-1 (PD-1) antibody developed by Chinese Hengrui Medicine. In conclusion, camrelizumab may be a good treatment option, especially in tumors that express PD-L1.
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Affiliation(s)
- Yi Chen
- Department of Oncology, Nanjing Pukou Central Hospital, Pukou Branch Hospital of Jiangsu Province Hospital, Nanjing 210000, People's Republic of China
| | - Hao Zhang
- Department of Oncology, Jiangsu Provincial People's Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Junfeng Shi
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210000, People's Republic of China
| | - Tongshan Wang
- Department of Oncology, Jiangsu Provincial People's Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, People's Republic of China
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Fan J, Fang Q, Yang Y, Cui M, Zhao M, Qi J, Luo R, Du W, Liu S, Sun Q. Role of Heterotypic Neutrophil-in-Tumor Structure in the Prognosis of Patients With Buccal Mucosa Squamous Cell Carcinoma. Front Oncol 2020; 10:541878. [PMID: 33178577 PMCID: PMC7593655 DOI: 10.3389/fonc.2020.541878] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Objective To analyze the role of frequency of heterotypic neutrophil-in-tumor structure (FNiT) in the prognosis of patients with buccal mucosa squamous cell carcinoma (BMSCC). Methods In vitro, we cocultured BMSCC cell line-H157 with neutrophils to form heterotypic neutrophil-in-tumor structures, which were then subject to fluorescence staining. Clinically, 145 patients were retrospectively enrolled. Associations between FNiT and clinicopathological variables including age, sex, smoking history, drinking history, betel nut chewing, tumor stage, node stage, metastasis, disease stage, lymphovascular invasion, extranodal extension, perineural invasion, and tumor grade were analyzed by chi-square test, and the main endpoints of interest were recurrence-free survival (RFS) and disease-specific survival (DSS) which were analyzed by the Kaplan-Meier method and Cox model. Results Fluorescent staining results of typical heterotypic neutrophil-in-tumor structure showed that well-differentiated H157 cells had a stronger ability to internalize more neutrophils than poorly-differentiated H157 cells, with the latter often internalizing only one neutrophil or nothing. The mean FNiT was 4.2‰, with a range from 2.3‰ to 7.8‰. A total of 80 patients relapsed and 84 patients died of the disease. The 5-year RFS and DSS rate was 42% and 42%, respectively. Patients with an FNiT≥4.2‰ had a significantly higher risk for locoregional recurrence and cancer-caused death than those with an FNiT<4.2‰ (p=0.001 and p<0.001, respectively). The FNiT alone was independently significant in predicting poor RFS, and the FNiT along with tumor grade was an independent predictor for DSS. Conclusion The FNiT as a novel predictor is significantly negatively associated with both the RFS and DSS of patients with BMSCC.
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Affiliation(s)
- Jie Fan
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.,Laboratory of Cell Engineering, Institute of Biotechnology, Beijing, China
| | - Qigen Fang
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yang Yang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Cui
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ming Zhao
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jinxing Qi
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Wei Du
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.,Department of Anatomy, Zhengzhou University, Zhengzhou, China
| | - Shanting Liu
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qiang Sun
- Laboratory of Cell Engineering, Institute of Biotechnology, Beijing, China
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Li X, Wu D, Liu H, Chen J. Pulmonary sarcomatoid carcinoma: progress, treatment and expectations. Ther Adv Med Oncol 2020; 12:1758835920950207. [PMID: 32922522 PMCID: PMC7450456 DOI: 10.1177/1758835920950207] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/23/2020] [Indexed: 01/10/2023] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a unique, highly invasive pulmonary malignancy with a poor prognosis, representing 0.1-0.4% of all malignant lung tumors. Because of its highly aggressive character and propensity for frequent metastasis, PSC shows low response rates to traditional treatments such as chemotherapy, radiotherapy, and neoadjuvant therapy. In recent years, considerable progress has been made in gene sequencing, targeted therapies, and immunotherapies. One of the most promising treatment approaches is the selection of mono-targeted or multi-targeted drugs according to tumor gene-mutation sites, such as epidermal growth factor receptor or vascular endothelial growth factor receptor 2 (EGFR/VEGFR2), anaplastic lymphoma kinase (ALK), and others. Another approach is the activation of therapeutic anti-tumor immunity via pathways including programmed cell-death protein-1/programmed cell-death ligand-1 (PD-1/PD-L1), which has been used in individual cases. In this review, we will introduce the clinicopathologic features, molecular typing, and traditional treatments. We will also review the biological characteristics and the latest therapies for PSC. These novel therapies show promise in the management of PSC, and the outcomes of investigative trials will hopefully reveal a variety of treatment options for patients with PSC.
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Affiliation(s)
- Xin Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Di Wu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Anshan Road no.154, Heping District, Tianjin 300052, China
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27
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Ağaçkıran Y, Aksu F, Akyürek N, Ercan C, Demiröz M, Aksu K. Programmed death ligand-1 expression levels, clinicopathologic features, and survival in surgically resected sarcomatoid lung carcinoma. Asia Pac J Clin Oncol 2020; 17:280-288. [PMID: 32929886 DOI: 10.1111/ajco.13460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To determine the programmed death ligand-1 (PD-L1) expression rates in sarcomatoid lung carcinomas and to compare clinicopathologic features and survival rates of PD-L1-positive and negative patients. METHODS PD-L1 expression was evaluated in 65 surgically resected sarcomatoid carcinomas. The clinicopathologic features of cases with PD-L1-positive and negative tumors were compared. Kaplan-Meier survival analysis was performed. Multiple Cox proportional hazard regression analysis was performed to determine independent predictors of overall survival. RESULTS PD-L1 antibody positivity was found in 72.3% of surgically resected sarcomatoid lung carcinomas. Regarding histopathologic subtypes, PD-L1 expression was positive in 80.4% of pleomorphic carcinomas, 62.5% of spindle- and/or giant-cell carcinomas, and 16.7% of carcinosarcomas. Pleural invasion was observed in 68.1% of PD-L1-positive cases and 27.8% of PD-L1-negative cases (P = 0.008). No difference in survival was found between PD-L1-positive and -negative tumors. The only factor significantly associated with poor survival was the pathological stage of the tumor. CONCLUSIONS This study reveals a high rate of PD-L1 positivity in a large number of sarcomatoid lung carcinoma cases with pleomorphic carcinoma, spindle- and/or giant-cell carcinoma, and carcinosarcoma subtypes. The only significantly different clinicopathologic feature in PD-L1-positive cases is pleural invasion. PD-L1 positivity is not a significant predictor of survival in sarcomatoid lung carcinomas.
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Affiliation(s)
- Yetkin Ağaçkıran
- Department of Pathology, Health Sciences University, Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Funda Aksu
- Department of Chest Diseases, Health Sciences University, Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Nalan Akyürek
- Department of Pathology, Gazi University School of Medicine, Ankara, Turkey
| | - Caner Ercan
- Instute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Mustafa Demiröz
- Department of Chest Surgery, Health Sciences University, Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Kurtuluş Aksu
- Department of Chest Diseases, Division of Immunology and Allergy, Health Sciences University, Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
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Jeong JH, Seo HJ, Yoon SH, Hong R. Pulmonary pleomorphic carcinoma presenting as undifferentiated non-small cell carcinoma with giant cells: A case report and review of literature. Respir Med Case Rep 2020; 31:101225. [PMID: 33005565 PMCID: PMC7511725 DOI: 10.1016/j.rmcr.2020.101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022] Open
Abstract
Pulmonary pleomorphic carcinoma (PPC) is a poorly differentiated non-small cell lung carcinoma, including squamous cell carcinoma, adenocarcinoma, or undifferentiated non-small cell lung carcinoma with at least 10% spindle and/or giant cells. Here, we report a case of PPC showing undifferentiated non-small cell lung carcinoma with giant cells. A 71-year-old man with dyspnea underwent right lobectomy because of a mass in the right upper lobe of the lung. A 5.0 × 3.0 × 1.5 cm-sized tumor was identified; microscopically, the tumor composed of undifferentiated large sized tumor cells admixed with syncytial tumor giant cells and emperipoletic giant cells. Immunohistochemically, the tumor cells were reactive for pan-cytokeratin, but negative for P40, thyroid transcription factor 1 (TTF-1), and vimentin. The tumor cells were also positive for 3 clones of programmed death-ligand 1 (PD-L1). The clinical and histologic findings supported the diagnosis of an undifferentiated non-small cell lung carcinoma with giant cells, which is a subtype of pulmonary pleomorphic carcinoma. Unfortunately, after surgery, multifocal lymph node metastasis was identified in radiologic examination. Only palliative chemotherapy was administered to the patient, although he was indicated for immunochemotherapy. Pulmonary pleomorphic carcinoma is known to have a poor prognosis, even in early stages of the disease, therefore, we should be careful in the diagnosis to ensure optimal treatment.
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Affiliation(s)
- Jae-Han Jeong
- Department of Thoracic and Cardiovascular Surgery, Republic of Korea
| | - Hong-Joo Seo
- Department of Thoracic and Cardiovascular Surgery, Republic of Korea
| | - Sung-Ho Yoon
- Department of Internal Medicine, Republic of Korea
| | - Ran Hong
- Department of Pathology College of Medicine, Chosun University, Gwangju, Republic of Korea
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Results of treating primary pulmonary sarcomas and pulmonary carcinosarcomas. J Thorac Cardiovasc Surg 2020; 162:274-284. [PMID: 32711968 DOI: 10.1016/j.jtcvs.2020.03.179] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/15/2020] [Accepted: 03/24/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Primary pulmonary sarcomas (PPS) and pulmonary carcinosarcomas (PCS) are rare aggressive lung malignancies. We reviewed our 21-year experience with the surgical and nonsurgical treatment of both tumors, comparing their clinical, histopathologic, and treatment results. METHODS All patients with PPS or PCS who underwent surgical and nonsurgical treatment between 1998 and 2019 at our cancer center were retrospectively reviewed. Multivariable Cox proportional hazards model was constructed. RESULTS In total, 100 patients were analyzed: 45 with PPS and 55 with PCS. Among patients with PPS, 31 of 45 (69%) underwent surgery with 1 (3%) operative mortality. For patients with PCS, 29 of 55 (53%) underwent surgery with no operative mortality. Patients with PPS were younger than PCS (P < .01). Fewer patients were smokers among PPS (58%) versus PCS (93%) (P < .01). For resected PPS, mean tumor size was 8.2 ± 4.1 cm (range 2.2-18.0) compared with 10.1 ± 5.0 cm (range 3.9-17.0) for unresected PPS. Tumor size for resected PCS was 6.2 ± 2.6 cm (range 2.0-10.5) versus 6.8 ± 3.5 cm (range 1.2-13.5) for unresected PCS. Of resected patients, 5 of 31 (16%) with PPS and 9 of 29 (31%) with PCS were node positive. Overall survival estimates were as follows: for PPS, median survival and 5-year overall survival for resected versus unresected cases were 39.6 months/28.7% versus 4.9 months/7.8%. For PCS, survival estimates were 23.6 months/31.0% versus 14.9 months/28.2%, respectively. In multivariable analyses (N = 100), age, smoking history, histology, and surgery were risk factors of survival. CONCLUSIONS At initial evaluation, PPS and PCS presented with large-sized tumors and usually were not stage I. Surgery had a positive impact on survival among patients with PPS. Whenever feasible, surgical resection, even in locally advanced disease, may yield long-term survival in these aggressive lung tumors, although the level of evidence is low.
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30
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Iijima Y, Nakajima Y, Kinoshita H, Nishimura Y, Iizuka T, Akiyama H, Hirata T. Clinicopathological Analysis of 17 Surgically Resected Pulmonary Pleomorphic Carcinoma Cases. Ann Thorac Cardiovasc Surg 2020; 27:1-9. [PMID: 32493871 PMCID: PMC8043029 DOI: 10.5761/atcs.oa.20-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To determine the outcomes and prognostic factors associated with pulmonary resection of pulmonary pleomorphic carcinoma (PPC). METHODS During 2008-2017, 17 patients underwent pulmonary resection for primary PPC at the Saitama Cancer Center, Japan. We investigated clinicopathological characteristics and outcomes of these cases. Overall survival (OS) and disease-free survival (DFS) rates were determined using Kaplan-Meier method and compared using log-rank test. Univariate analysis was performed to identify prognostic factors. RESULTS The 5-year OS and DFS rates were 27.2% and 51.0%, respectively. The median follow-up period was 30.8±24.9 (3.6-92.8) months after pulmonary resections. Patients with disease-free interval (DFI) <1 year of resection had poorer prognosis than those without (p = 0.001). Patients with N2 status and adenocarcinoma components had significantly poorer disease-free prognosis than their counterparts (p = 0.021 and p = 0.019, respectively). Univariate analysis revealed that DFI <1 year was an unfavorable prognostic factor for OS (p = 0.005); N2 pathological status and presence of adenocarcinoma components were unfavorable prognostic factors for DFS (p = 0.038 and p = 0.036, respectively). CONCLUSION PPC patients with an adenocarcinoma component and N2 pathological status may have an earlier relapse and poorer prognosis than their counterparts. Further assessment of cases may help clarify the predictors of PPC.
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Affiliation(s)
- Yoshihito Iijima
- Division of Thoracic Surgery, Saitama Cancer Center, Ina, Saitama, Japan
| | - Yuki Nakajima
- Division of Thoracic Surgery, Saitama Cancer Center, Ina, Saitama, Japan
| | - Hiroyasu Kinoshita
- Division of Thoracic Surgery, Saitama Cancer Center, Ina, Saitama, Japan
| | - Yu Nishimura
- Division of Pathology, Saitama Cancer Center, Ina, Saitama, Japan
| | - Toshihiko Iizuka
- Division of Pathology, Saitama Cancer Center, Ina, Saitama, Japan
| | - Hirohiko Akiyama
- Division of Thoracic Surgery, Saitama Cancer Center, Ina, Saitama, Japan
| | - Tomomi Hirata
- Division of Thoracic Surgery, Saitama Cancer Center, Ina, Saitama, Japan
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31
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Choshi H, Watanabe M, Ujike H, Sato Y, Morito T, Sugimoto R, Kataoka K. Resected case of stage IV pleomorphic carcinoma of the lung with long-term survival. Surg Case Rep 2020; 6:106. [PMID: 32448928 PMCID: PMC7246230 DOI: 10.1186/s40792-020-00868-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background No established treatments for pulmonary pleomorphic carcinoma exist because of its rarity, and the prognosis is poorer than that of other non-small cell lung cancers. Case report We present a case of stage IV pleomorphic carcinoma; the patient was a 66-year-old male. He was referred to our hospital because of a right adrenal hemorrhage and a lung tumor. A systemic examination revealed that the lung tumor was a primary lung cancer and that the adrenal hemorrhage was due to a metastatic cancer. We performed an adrenalectomy and resection of the lung tumor and obtained a diagnosis of pleomorphic carcinoma with adrenal metastasis. The patient has remained recurrence-free for 6 years since the surgery. Conclusions We report a patient with stage IV pleomorphic carcinoma of the lung and an oligometastasis in whom a complete resection enabled a good outcome. Additional reports are needed to clarify definite prognostic factors and the optimal treatment for pleomorphic carcinoma.
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Affiliation(s)
- Haruki Choshi
- Department of Thoracic Surgery, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan
| | - Mototsugu Watanabe
- Department of Thoracic Surgery, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
| | - Hiroyuki Ujike
- Department of Thoracic Surgery, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan
| | - Yumiko Sato
- Department of Diagnostic Pathology, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Toshiaki Morito
- Department of Diagnostic Pathology, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Ryujiro Sugimoto
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Touon-shi, Ehime, Japan
| | - Kazuhiko Kataoka
- Department of Thoracic Surgery, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan
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Imai H, Kaira K, Endoh H, Imaizumi K, Goto Y, Kamiyoshihara M, Kosaka T, Yajima T, Ohtaki Y, Osaki T, Kogure Y, Tanaka S, Fujita A, Oyama T, Minato K, Asao T, Shirabe K. Prognostic Significance of Glucose Metabolism as GLUT1 in Patients with Pulmonary Pleomorphic Carcinoma. J Clin Med 2020; 9:jcm9020413. [PMID: 32028659 PMCID: PMC7074371 DOI: 10.3390/jcm9020413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 01/28/2023] Open
Abstract
Glucose metabolism is necessary for tumor progression, metastasis, and survival in various human cancers. Glucose transporter 1 (GLUT1), in particular, plays an important role in the mechanism of ¹⁸F-FDG (2-[¹⁸F]-fluoro-2-deoxy-d-glucose) within tumor cells. However, little is known about the clinicopathological significance of GLUT1 in patients with pulmonary pleomorphic carcinoma (PPC). Adenocarcinoma, squamous cell carcinoma, adenosquamous cell carcinoma, poorly differentiated carcinoma, large cell carcinoma, and others were identified as epithelial components, and spindle-cell type, giant-cell type, and both spindle- and giant-cell types were identified as sarcomatous components. This study was performed to determine the prognostic impact of GLUT1 expression in PPC. Patients with surgically resected PPC (n = 104) were evaluated by immunohistochemistry analysis to detect GLUT1 expression and determine the Ki-67 labeling index using specimens of the resected tumors. GLUT1 was highly expressed in 48% (50/104) of all patients, 42% (20/48) of the patients with an adenocarcinoma component, and 53% (30/56) of the patients with a nonadenocarcinoma component. High expression of GLUT1 was significantly associated with advanced stage, vascular invasion, pleural invasion, and tumor cell proliferation as determined by Ki-67 labeling. GLUT1 expression and tumor cell proliferation were significantly correlated according to the Ki-67 labeling in all patients (Spearman’s rank; r = 0.25, p < 0.01). In multivariate analysis, GLUT1 was identified as a significant independent marker for predicting a poor prognosis. GLUT1 is an independent prognostic factor for predicting the poor prognosis of patients with surgically resected PPC.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota 373-8550, Japan; (H.I.); (K.M.)
| | - Kyoichi Kaira
- Department of Innovative Immune-Oncology Therapeutics, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; (T.Y.); (K.S.)
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka 350-1298, Japan
- Correspondence: ; Tel.: +81-27-220-8222; +81-42-984-4111
| | - Hideki Endoh
- Department of Thoracic Surgery, Saku Central Hospital Advanced Care Center, Saku 385-0051, Japan;
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University, Toyoake 470-1192, Japan; (K.I.); (Y.G.)
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University, Toyoake 470-1192, Japan; (K.I.); (Y.G.)
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi 371-0811, Japan;
| | - Takayuki Kosaka
- Division of Thoracic Surgery, Takasaki General Medical Center, Takasaki 370-0829, Japan;
| | - Toshiki Yajima
- Department of Innovative Immune-Oncology Therapeutics, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; (T.Y.); (K.S.)
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
| | - Yoichi Ohtaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
| | - Takashi Osaki
- Department of Respiratory Medicine, Shibukawa Medical Center, Shibukawa 377-0280, Japan;
| | - Yoshihito Kogure
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya 460-0001, Japan;
| | - Shigebumi Tanaka
- Department of Respiratory Surgery, Isesaki Municipal Hospital, Isesaki 372-0817, Japan;
| | - Atsushi Fujita
- Division of Thoracic Surgery, Gunma Prefectural Cancer Center, Ota 373-8550, Japan;
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota 373-8550, Japan; (H.I.); (K.M.)
| | - Takayuki Asao
- Big Data Center for Integrative Analysis, Gunma University Initiative for Advance Research, Maebashi 371-8511, Japan;
| | - Ken Shirabe
- Department of Innovative Immune-Oncology Therapeutics, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; (T.Y.); (K.S.)
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
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Iijima Y, Nakajima Y, Kinoshita H, Kurihara Y, Nishimura Y, Iizuka T, Akiyama H, Hirata T. A case of resected primary pulmonary pleomorphic carcinoma with long-term survival after multidisciplinary treatment. Surg Case Rep 2020; 6:28. [PMID: 31993853 PMCID: PMC6987290 DOI: 10.1186/s40792-020-0794-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/14/2020] [Indexed: 12/31/2022] Open
Abstract
Background Generally, primary pulmonary pleomorphic carcinoma is resistant to treatment and has a poor prognosis. We report a case of resected primary pulmonary pleomorphic carcinoma with long-term survival after multidisciplinary treatment. Case presentation A 74-year-old man with a history of emphysema, pneumoconiosis, and chronic bronchitis presented with left lung nodule and left adrenal tumor based on computed tomography. We suspected clinical T1bN0M1b, stage IVB lung cancer. Adrenalectomy of the left adrenal tumor yielded a definitive diagnosis of pleomorphic carcinoma. Chemotherapy was performed despite the spontaneous regression of lung lesions. Since lung lesions re-enlarged 11 months after adrenalectomy, the left lower lobe was partially resected followed by chemotherapy. The lung lesion was the primary lesion of the adrenal tumor. There was no recurrence 100 months after the lung resection. Conclusions The patient experienced long-term survival after multidisciplinary treatment. Both multidisciplinary treatment and immunological mechanisms caused spontaneous regression of the primary lesion.
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Affiliation(s)
- Yoshihito Iijima
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita adachi-gun, Saitama, 362-0806, Japan.
| | - Yuki Nakajima
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita adachi-gun, Saitama, 362-0806, Japan
| | - Hiroyasu Kinoshita
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita adachi-gun, Saitama, 362-0806, Japan
| | - Yasuyuki Kurihara
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita adachi-gun, Saitama, 362-0806, Japan
| | - Yu Nishimura
- Division of Pathology, Saitama Cancer Center, Saitama, Japan
| | | | - Hirohiko Akiyama
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita adachi-gun, Saitama, 362-0806, Japan
| | - Tomomi Hirata
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita adachi-gun, Saitama, 362-0806, Japan
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Baldovini C, Rossi G, Ciarrocchi A. Approaches to Tumor Classification in Pulmonary Sarcomatoid Carcinoma. LUNG CANCER-TARGETS AND THERAPY 2019; 10:131-149. [PMID: 31824199 PMCID: PMC6901065 DOI: 10.2147/lctt.s186779] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a heterogeneous category of primary lung cancer accounting from 0.3% to 3% of all primary lung malignancies. According to the most recent 2015 World Health Organization (WHO) classification, PSC includes several different variants of malignant epithelial tumors (carcinomas) histologically mimicking sarcomas showing or entirely lacking a conventional component of non-small cell lung cancer (NSCLC). Thus, this rare subheading of lung neoplasms includes pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, pulmonary blastoma, and carcinosarcoma. A diagnosis of PSC may be suspected on small biopsy or cytology, but commonly requires a surgical resection to reach a conclusive definition. The majority of patients with PSC consists of elderly, smoking men with a large, peripheral mass characterized by well-defined margins. However, presentation with a central, polypoid endobronchial lesion is well-documented, particularly in pleomorphic carcinoma and carcinosarcoma showing a squamous cell carcinoma component. As expected, PSC may pose diagnostic problems and immunohistochemistry is largely used when pathologists deal these tumors in routine practice. Indeed, PSC tends to overexpress molecules associated with the epithelial-to-mesenchymal transition, such as vimentin, but the panel of immunostains also includes epithelial markers (cytokeratins, EMA), TTF-1, p40 and negative markers (e.g., melanocytic, mesothelial and sarcoma-related primary antibodies). Although rare, PSC has increased their interest among oncologist community for different reasons: a. identification of the epithelial-to-mesenchymal phenomenon as a major mechanism of secondary resistance to tyrosine kinase inhibitors; b. over-expression of PD-L1 and effective treatment with immunotherapy; c. identification of c-MET exon 14 skipping mutation representing an effective target to crizotinib and other specific inhibitors. In this review, the feasibility of the diagnosis of PSC, its differential diagnosis and novel molecular findings characterizing this group of lung tumor are discussed.
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Affiliation(s)
- Chiara Baldovini
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, Hospital S. Maria delle Croci, Ravenna, Italy
| | - Giulio Rossi
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, Hospital S. Maria delle Croci, Ravenna, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia 42123, Italy
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Clinical Significance of Various Drug-Sensitivity Markers in Patients with Surgically Resected Pulmonary Pleomorphic Carcinoma. Cancers (Basel) 2019; 11:cancers11111636. [PMID: 31653009 PMCID: PMC6895922 DOI: 10.3390/cancers11111636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 01/10/2023] Open
Abstract
Various drug-sensitivity markers are potentially responsible for tumor progression and chemotherapy resistance in cancer patients with both epithelial and sarcomatous components; however, the clinicopathological significance of drug-sensitivity markers in patients with pulmonary pleomorphic carcinoma (PPC) remains unknown. Here, we clarified the prognostic impact of these drug-sensitivity markers in PPC by performing immunohistochemical and clinicopathologic analyses of samples from 105 patients with surgically resected PPC in order to evaluate levels of vascular endothelial growth factor 2 (VEGFR2), stathmin 1 (STMN1), tubulin β3 class III (TUBB3), thymidylate synthetase (TS), topoisomerase II (Topo-II), glucose-regulated protein, and 78 kDa (GRP78)/binding immunoglobulin protein (BiP). We observed the rates of high expression for VEGFR2, STMN1, TUBB3, TS, Topo-II, and GRP78/BiP were 33% (39/105), 35% (37/105), 61% (64/105), 51% (53/105), 31% (33/105), and 51% (53/105) of the samples, respectively. Moreover, multivariate analysis identified VEGFR2 and GRP78/BiP as significant independent markers for predicting worse prognosis. These findings suggested elevated VEGFR2 and decreased GRP78/BiP levels as independent factors for predicting poor outcomes following surgical resection in patients with PPC.
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Multiclonality and Radiosensitivity of Granulocyte-colony Stimulating Factor-Producing Lung Adenocarcinoma Positive for an Activating EGFR Mutation. Clin Lung Cancer 2019; 21:e21-e24. [PMID: 31649000 DOI: 10.1016/j.cllc.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/09/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022]
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Sun L, Dai J, Wang X, Jiang G, Gonzalez-Rivas D, Song J, Zhang P. Pulmonary carcinosarcoma: analysis from the Surveillance, Epidemiology and End Results database. Interact Cardiovasc Thorac Surg 2019; 30:4-10. [PMID: 31518405 DOI: 10.1093/icvts/ivz215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 12/25/2022] Open
Abstract
AbstractOBJECTIVESPulmonary carcinosarcoma (PCS) is a rare neoplasm. This study explored the clinicopathological characteristics and survival outcomes of PCS.METHODSThe Surveillance, Epidemiology and End Results (SEER) database (1988–2014) was queried for PCS. Overall survival (OS) was evaluated by multivariable Cox regression and nomograms were constructed to predict 3-year OS for PCS. Prognostic performance was evaluated using concordance index and area under the curve analysis. In M0 surgically treated patients, interaction assessments were performed using likelihood ratio tests. Subgroup analysis was performed according to patient age. The clinical features of PCSs were further compared to other non-small-cell lung cancers (NSCLCs).RESULTSMultivariable analysis identified age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01–1.04], surgery (HR 0.53, 95% CI 0.36–0.77) and chemotherapy (HR 0.51, 95% CI 0.36–0.73) as significantly associated with OS. The nomogram had a concordance index of 0.747 and an area under the curve of 0.803. The association between age and OS was stronger in those receiving pneumonectomy (P = 0.04 for interactions) compared to those that did not (HR 5.14, 95% CI 1.64–16.07), and was associated with a poorer outcome compared to lobectomy amongst the elderly (age ≥ 70 years). Patients with PCS were more likely to receive surgical treatment and had lower lymphatic metastasis compared to adenocarcinoma, squamous cell carcinoma and large cell carcinoma (all P < 0.05).CONCLUSIONSPCS had unique clinical features compared to common types of NSCLCs in terms of lymphatic invasion and surgical treatment. Pneumonectomy was associated with poorer survival in elderly patients.
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Affiliation(s)
- Liangdong Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xujun Wang
- Department of SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Jiong Song
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Validity of using immunohistochemistry to predict treatment outcome in patients with non-small cell lung cancer not otherwise specified. J Cancer Res Clin Oncol 2019; 145:2495-2506. [DOI: 10.1007/s00432-019-03012-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022]
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Yang Y, Mei J, Lin F. Pleomorphic carcinoma of the lung: from thin-walled cavity to solid tumor. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:273. [PMID: 31355240 DOI: 10.21037/atm.2019.05.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pulmonary pleomorphic carcinoma accounts for less than 1% of all lung malignancies. It is more aggressive than other forms of non-small cell lung cancer, and usually presented as a solid mass on computed tomography scan. However, a thin-walled lung cavity is more suggestive of a benign lesion in generally. Here we encountered a 39-year-old woman, who had been found a thin-walled cavity in her lung occasionally, whose chest computed tomography initially presented as a thin-walled lung cavity which was considered to be a benign lung cyst, became a solid tumor after 3 years. Then she underwent video-assisted thoracoscopic left lower lobectomy and lymphadenectomy, postoperative pathological examination demonstrated the diagnosis of pleomorphic carcinoma.
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Affiliation(s)
- Yanbo Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Borczuk AC. Uncommon Types of Lung Carcinoma With Mixed Histology: Sarcomatoid Carcinoma, Adenosquamous Carcinoma, and Mucoepidermoid Carcinoma. Arch Pathol Lab Med 2019; 142:914-921. [PMID: 30040455 DOI: 10.5858/arpa.2017-0584-ra] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Lung tumors are histologically heterogeneous, but classification of lung carcinoma has prognostic impact and increasingly, specific molecular correlates. OBJECTIVE - To update the gross, microscopic, and molecular pathology of unusual lung carcinomas to assure accurate classification. In entities with mixed histology, the recognition of specific features or rare patterns is critical to diagnosis. These diagnoses can identify tumors with aggressive clinical behavior, and diagnostic pitfalls can therefore result in underdiagnosis of these already rare entities. Incorrect classification of more indolent tumors into the more aggressive categories can also occur. In the area of molecular pathology, these unusual tumors have a specific spectrum of molecular alterations. DATA SOURCES - PubMed searches for lung and sarcomatoid carcinoma, pleomorphic carcinoma, blastoma, carcinosarcoma, and adenosquamous and mucoepidermoid carcinoma were undertaken and this information was integrated with clinical experience of the author. CONCLUSIONS - These uncommon carcinomas have specific clinicopathologic features, and attention to their gross and microscopic pathology leads to classification with important associated molecular findings.
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Tokuyasu H, Ishikawa S, Sakai H, Ikeuchi T, Miura H. Single pembrolizumab treatment causing profound durable response in a patient with pulmonary pleomorphic carcinoma. Respir Med Case Rep 2019; 28:100879. [PMID: 31249776 PMCID: PMC6586952 DOI: 10.1016/j.rmcr.2019.100879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022] Open
Abstract
We report a case of a 73-year-old man diagnosed with pulmonary pleomorphic carcinoma who showed profound durable response after a single treatment with pembrolizumab. The patient underwent a diagnostic workup in our hospital due to a hoarseness of voice. Chest computed tomography revealed a massive pulmonary tumor in the left upper lobe and multiple nodules in the both lung fields. Histological examination of a transbronchial lung biopsy specimen revealed pulmonary pleomorphic carcinoma. First-line treatment with pembrolizumab was discontinued after a single administration due to treatment-related pneumonitis. However, durable response has been observed over 17 months to date.
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Affiliation(s)
- Hirokazu Tokuyasu
- Divisions of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan
| | - Soichiro Ishikawa
- Divisions of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan
| | - Hiromitsu Sakai
- Divisions of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan
| | - Tomoyuki Ikeuchi
- Divisions of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan
| | - Hiroshi Miura
- Divisions of Pathology, Matsue Red Cross Hospital, Shimane, Japan
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Khan S, Dahal B, Siddiqui F, Norville KJ, Karki A. Pulmonary Spindle Cell Carcinoma: A Rare Case Report. Cureus 2019; 11:e4737. [PMID: 31355096 PMCID: PMC6649890 DOI: 10.7759/cureus.4737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spindle cell carcinoma is a rare pulmonary malignancy. The prognosis and treatments are unclear, with limited literature available. Here, we report a man who underwent bronchoscopy with an endobronchial biopsy after complaining of dyspnea on exertion. Computed tomography (CT) chest showed a 10 x 3 cm mass in the right upper lobe. Biopsy revealed spindle cell carcinoma, and he was referred to hematology for chemotherapy. He was lost to follow-up recently.
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Affiliation(s)
- Salman Khan
- Internal Medicine, Guthrie Clinic/Robert Packer Hospital, Sayre, USA
| | - Binita Dahal
- Internal Medicine, Guthrie Clinic/Robert Packer Hospital, Sayre, USA
| | - Faraz Siddiqui
- Internal Medicine - Critical Care, Guthrie Clinic/Robert Packer Hospital, Sayre, USA
| | - Kim J Norville
- Internal Medicine - Critical Care, Guthrie Clinic/Robert Packer Hospital, Sayre, USA
| | - Apurwa Karki
- Internal Medicine - Critical Care, Guthrie Clinic/Robert Packer Hospital, Sayre, USA
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Hendriksen BS, Hollenbeak CS, Reed MF, Taylor MD. Perioperative chemotherapy is not associated with improved survival in stage I pleomorphic lung cancer. J Thorac Cardiovasc Surg 2019; 158:581-591.e11. [PMID: 31122617 DOI: 10.1016/j.jtcvs.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/14/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Pulmonary pleomorphic carcinoma represents an understudied, rare, and aggressive histologic subtype of non-small cell lung cancer. Better understanding of rare disease subtypes allows for improved individualization of patient care. This study aimed to evaluate current trends in treatment and survival of pleomorphic carcinoma. METHODS The National Cancer Database was used to identify patients with staged, pleomorphic carcinoma and adenocarcinoma between 2004 and 2015. Patient characteristics and treatments were compared using χ2 tests. Cox proportional hazard models examined survival by stage after controlling for confounders. Propensity score matched Kaplan-Meier curves estimated survivor functions stratified by stage. Differences in survival following treatment for stage I pleomorphic carcinoma with surgery alone versus surgery plus chemotherapy were compared with Cox proportional hazard models and Kaplan-Meier survival curves. RESULTS One thousand four hundred eight patients with pleomorphic carcinoma and 607,561 patients with adenocarcinoma were identified. Pleomorphic carcinoma accounted for 0.1% of all non-small cell lung cancers. Pleomorphic disease had poorer overall 5-year survival compared with adenocarcinoma for stages I through IV (49.4% vs 59.1%, 34.5% vs 43.8%, 16.9% vs 28.4%, and 5.7% vs 7.8%, respectively; P < .0047 for all). Perioperative chemotherapy was used more frequently for pleomorphic disease (17.5% vs 6.1%; P < .001). For stage I pleomorphic cancer, treatment with surgery alone (n = 253) and surgery with chemotherapy (n = 57) had overall 5-year survival rates of 55.2% and 53.7%, respectively, and were not significantly different (P = .2868). CONCLUSIONS Pulmonary pleomorphic carcinoma is rare and aggressive, with worse survival when compared with adenocarcinoma. Perioperative chemotherapy has not demonstrated significant survival benefits in stage I pleomorphic cancer.
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Affiliation(s)
- Brandon S Hendriksen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa.
| | - Christopher S Hollenbeak
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa; Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pa; Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - Michael F Reed
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa
| | - Matthew D Taylor
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pa
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Naito M, Tamiya A, Takeda M, Taniguchi Y, Saijo N, Naoki Y, Okishio K, Yoon H, Kasai T, Matsumura A, Atagi S. A High PD-L1 Expression in Pulmonary Pleomorphic Carcinoma Correlates with Parietal-pleural Invasion and Might Predict a Poor Prognosis. Intern Med 2019; 58:921-927. [PMID: 30568128 PMCID: PMC6478980 DOI: 10.2169/internalmedicine.1462-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Pleomorphic carcinoma (PC) is a rare pulmonary epithelial malignant tumor with a poor prognosis. The objective of the present study was to investigate the programmed death-ligand 1 (PD-L1) expression in PC and its correlation between the clinicopathological factors and prognosis. Methods Clinical and pathological data of 35 patients with surgically resected PC encountered from 2002 to 2016 at our institution were collected. The PD-L1 expression on tumor cells was evaluated via immunohistochemistry (clone 22C3). We examined the correlation between the PD-L1 expression and patients' clinicopathological factors and their prognosis. Results A high PD-L1 expression (≥50%) was seen in 21 (60%) patients, and parietal-pleural invasion was significantly correlated with a high PD-L1 expression (p=0.012). The 5-year overall survival and relapse-free survival were 68.2% and 43.2%, respectively. Tumor size ≥50 mm (p=0.021), lymph node metastasis (p=0.023), and a high PD-L1 expression (p=0.047) were correlated with a short relapse-free survival. Since lymph node metastasis was an independent risk factor of a poor overall survival (p=0.012), patients with a high PD-L1 expression also tended to have a worse overall survival than those with low levels (p=0.081). Conclusion A high PD-L1 expression is frequently seen in PC. The PD-L1 expression is associated with parietal-pleural invasion and might indicate a poor prognosis.
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Affiliation(s)
- Maiko Naito
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Maiko Takeda
- Department of Laboratory Medicine and Pathology, Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Nobuhiko Saijo
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Yoko Naoki
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Kyoichi Okishio
- Department of Thoracic Oncology, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Hyungeun Yoon
- Department of Surgery, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Takahiko Kasai
- Department of Laboratory Medicine and Pathology, Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Akihide Matsumura
- Department of Surgery, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
| | - Shinji Atagi
- Department of Thoracic Oncology, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
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Yang KM, Tang EK, Goan YG, Tseng YC. A rare presentation of pleomorphic carcinoma of lung mimic empyema. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:52. [PMID: 30906756 DOI: 10.21037/atm.2018.12.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pleomorphic carcinoma (PC) of lung, a rare malignant lung tumor, is predominated in male smokers with over 65 years of age. The clinical presentations of PC are various including chest pain, cough, and dyspnea and so on. Asymptomatic patients have been also reported. In our case, a female non-smoker with middle age, who initially developed symptoms like empyema was diagnosed advanced PC. Poor progression occurred in this patient within one month from diagnosis to expiration. The lesson from this case is that malignancy of lung such as PC could not be excluded if a patient develops unmanageable empyema.
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Affiliation(s)
- Kuo-Ming Yang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - En-Kuei Tang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yih-Gang Goan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yen-Chiang Tseng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Seong YW, Han SJ, Jung W, Jeon JH, Cho S, Jheon S, Kim K. Perioperative change in neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in patients with completely resected primary pulmonary sarcomatoid carcinoma. J Thorac Dis 2019; 11:819-826. [PMID: 31019770 DOI: 10.21037/jtd.2019.02.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background There has been controversy regarding prognostic factors for surgically resected primary pulmonary sarcomatoid carcinoma (PSC). Recently, several studies have shown that neutrophil-to-lymphocyte ratio (NLR) was a prognostic factor for various types of cancers from multiple organs. Therefore, we performed this study to evaluate whether NLR is related to prognosis after complete surgical resection of primary PSC. Methods From Oct. 2003 to Sep. 2015, a total of 50 patients underwent surgical resection for primary PSC. After excluding patients with any history of other malignancy and incompletely resected cases, a total of 37 patients were included, and data were retrospectively collected and analyzed. Change in postoperative NLR and the initial NLR (ΔNLR) was calculated from the perioperative complete blood count (CBC) results. Results Mean age of the cohort was 62.2±1.9 years, and 31 patients (83.8%) were male. Twenty patients (54.1%) were revealed as pN0. Overall 5-year survival rate was 50.3%. Seventeen patients (45.9%) had locoregional or distant metastases. Univariate survival analysis revealed age >70, ΔNLR >17 as risk factors for overall survival (P=0.009, 0.005) and disease-free survival (P=0.036, 0.018). Multivariate Cox-regression analysis revealed age >70 and ΔNLR >17 as independent risk factors for overall survival and ΔNLR >17 as the only independent risk factor for the disease-free survival. Conclusions In patients with completely resected primary PSC, perioperative ΔNLR had a significant effect on the overall survival and disease-free survival. Older age was also an independent risk factor for overall survival.
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Affiliation(s)
- Yong Won Seong
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Joon Han
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woohyun Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lindholm KE, Kalhor N, Moran CA. Osteoclast-like giant cell–rich carcinomas of the lung: a clinicopathological, immunohistochemical, and molecular study of 3 cases. Hum Pathol 2019; 85:168-173. [DOI: 10.1016/j.humpath.2018.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022]
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Kotlowska MP, Rueda AG, Olmedo ME, Benito A, Roldán AS, Fernandez Méndez MA, Gorospe L, Palacios J, Garrido López P. Efficacy of immunotherapy in sarcomatoid lung cancer, a case report and literature review. Respir Med Case Rep 2019; 26:310-314. [PMID: 30931249 PMCID: PMC6409391 DOI: 10.1016/j.rmcr.2019.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/25/2022] Open
Abstract
Sarcomatoid carcinoma is a subtype of non-small cell lung cancer (NSCLC) characterized by mesenchymal – epithelial transition component and awful prognosis. In this report, based on a case of stage IV lung sarcomatoid carcinoma with an extraordinary evolution and survival over 4 years, we address unresolved questions about the treatment of this cancer. We also make a literature review about the key factors that characterize this histology and that should be considered when treating those patients. Sarcomatoid carcinoma presents with mutations as KRAS, EGFR, ALK or MET in up to 70% of cases, and an important expression of PD-L1 (also called B7-H1), which can influence treatment of those patients with new drugs as immune checkpoint inhibitors. Immunotherapy has changed the horizon of patients with stage IV lung cancers without driver mutations, as their survival has improved extraordinary. Moreover, radical treatments are being considered in long survivors with oligometastatic disease. In this report, we review targeted and radical therapy, treatment duration and the mechanisms responsible of disease evolution of sarcomatoid tumors. Sarcomatoid lung cancer is a rare entity with awful prognosis. It may express driver mutations for potential treatment of those patients. There are arising data of efficacy of immunotherapy in sarcomatoid lung carcinoma.
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Affiliation(s)
| | - Ana Gómez Rueda
- Thoracic Oncology Department, Universitary Hospital Ramon y Cajal, Madrid, Spain
| | - María Eugenia Olmedo
- Thoracic Oncology Department, Universitary Hospital Ramon y Cajal, Madrid, Spain
| | - Amparo Benito
- Pathology Department, Universitary Hospital Ramon y Cajal, Madrid, Spain
| | | | | | - Luis Gorospe
- Radiology Department, Universitary Hospital Ramon y Cajal, Madrid, Spain
| | - José Palacios
- Pathology Department, Universitary Hospital Ramon y Cajal, Madrid, Spain
| | - Pilar Garrido López
- Thoracic Oncology Department, Universitary Hospital Ramon y Cajal, Madrid, Spain
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Rahouma M, Kamel M, Narula N, Nasar A, Harrison S, Lee B, Stiles B, Altorki NK, Port JL. Pulmonary sarcomatoid carcinoma: an analysis of a rare cancer from the Surveillance, Epidemiology, and End Results database. Eur J Cardiothorac Surg 2019; 53:828-834. [PMID: 29240878 DOI: 10.1093/ejcts/ezx417] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/31/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Pulmonary sarcomatoid carcinoma (PSC) is a rare malignant neoplasm that accounts for a small percentage of non-small-cell lung carcinoma (NSCLC). At least 10% of PSCs has a spindle and/or giant cell component, which is often associated with a poor prognosis. We reviewed the Surveillance, Epidemiology, and End Results (SEER) database for the clinicopathological characteristics and surgical outcomes of PSCs. METHODS The SEER database (1973-2013) was queried for PSC. A comparison between PSC and other NSCLC patients was performed. Cox regression for overall survival (OS) and logistic regression for node-positive predictors were performed. A propensity-matched (1:2) analysis (including age, gender, grade and stage) among surgically treated cases was done to compare OS in PSC versus other NSCLCs. RESULTS A total of 955 899 NSCLC patients were identified; of these, 4987 patients had been diagnosed with PSC (0.52%). Men represented 60.9% of cases, with a median age of 68 years. The median size of the tumour was 5 cm and 3.5 cm in PSCs and NSCLCs, respectively (P < 0.001). PSC patients had significantly less Stage I, more high-grade tumours, advanced T stage, N+ disease and M1 disease (P < 0.001). In the PSC cohort, the most significant predictor of N+ disease on multivariate analysis was advanced T stage (P < 0.001). Predictors of OS in Stages I/II PSC on multivariate analysis were advanced age [P < 0.001, hazard ratio (HR) = 1.03], male gender (P = 0.024, HR = 1.25), carcinosarcoma (P = 0.002, HR = 1.76), grade (P = 0.033, HR = 1.81), T stage (P = 0.003, HR = 1.75), N status (P = 0.001, HR = 1.90) and surgical resection (P < 0.001, HR = 0.58). Among matched surgically resected cohorts, a poorer prognosis for OS was evident in PSCs in early stages (I/II) than in other NSCLCs (P = 0.009). CONCLUSIONS PSC patients present with more advanced stage and with worse survival outcomes than other NSCLC patients. While surgical resection conveys a survival advantage in PSC, this group represents a population at a high risk for relapse and should be evaluated for novel adjuvant therapies.
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Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Mohamed Kamel
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Navneet Narula
- Department of Pathology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Abu Nasar
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Benjamin Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Nasser K Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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50
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Moleyar V, Jyothsna BK. Unusual cause for hemoptysis in a young female. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2019. [DOI: 10.4103/mjdrdypu.mjdrdypu_157_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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