Pulmonary pleomorphic carcinoma; report of a case

We report a case of a 64-year-old man with pleomorphic carcinoma of the lung and thymic cyst. He was admitted to our hospital because of an abnormal shadow observed on chest X-ray. Computed tomography (CT) showed a mass lesion located in the right upper lobe and a non-invasive anterior mediastinal tumor adjacent to the left brachiocepharic vein. On enhanced CT, the lung mass showed central low-attenuation areas with a substantial enhancement in the periphery. Preoperative transbronchial blushing cytology of the mass revealed adenocarcinoma. With a diagnosis of primary lung cancer (cT3N0M0) and mediastinal tumor, an operation was performed through a median sternotomy. The mediastinal tumor was excised and a right upper lobectomy and were also accomplished, because the lung tumor did not show adhesion or pleural invasion. Histopathologic examination of the resected specimen revealed that the lung tumor composed of a mixture of spindle and giant cell features and contained a component of adenocarcinoma and squamous cell carcinoma. This finding yielded a pathological diagnosis of pleomorphic carcinoma (pT2N0M0). The mediastinal tumor was diagnosed as thymic cyst. The postoperative course was uneventful, and he is currently well 6 months after surgery.     

Pleomorphic Carcinoma of the Lung with Mediastinal Extension Following Malignant Lymphoma: Report of a Case

In following up a patient with non-Hodgkin's lymphoma, we encountered a case of pulmonary pleomorphic carcinoma with mediastinal direct invasion. A 65-year-old man with hemoptysis was found to have an abnormal shadow in the right upper lung field. A 6.4 × 4.8-cm tumor adjacent to the upper mediastinum occupied the right anterior segment of the upper lobe (S3) and invaded the superior vena cava (SVC). The serum level of neuron-specific enolase was elevated to 11.9 ng/ml. A specimen from a transbronchial lung biopsy of the right B3b bronchus revealed giant tumor cells. A right upper lobectomy with SVC reconstruction was performed. The resected tumor was diagnosed as a pulmonary pleomorphic carcinoma with a large component of giant and spindle cells, and it is considered to be a rare histologic type.     

A case with esophageal carcinoma associated with metastatic pulmonary tumor in lung cancer at seven years after the resection of lung cancer

A 69-year-old woman was admitted to our hospital because of dysphasia. The upper G-I examination showed a stenosis at the middle thoracic esophagus and poorly differentiated adenocarcinoma was revealed histologically. Chest CT scan showed a mass shadow in the right upper lobe of the lung. She had undergone a partial resection of right upper lobe because of lung cancer seven years before. She was diagnosed as metachrous double carcinoma of the lung and the esophagus. The method of surgery included right upper lobectomy of the lung, esophagectomy and intrathoracic esophageal reconstruction using the gastric tube. The patient manifested pneumonia due to the failure of the sutures after the surgery and died on the twentieth postoperative day. When conducting simultaneous resection of both cancer and esophageal reconstruction for the double cancer of the lung and the esophagus, it was considered necessary to conduct the anastomosis outside the thoracic cavity for the purpose of preventing the pulmonary complication due to the failure of the sutures.     

Primary pulmonary collision cancer consisting of large cell carcinoma and adenocarcinoma

A case of pulmonary collision tumor is herein reported. An abnormal shadow was discovered in the right lung of a 53-year-old man. A right upper lobectomy with a mediastinal lymph node dissection was performed. Based on the findings of a postoperative pathologic examination, this tumor was considered to be a collision tumor of large cell carcinoma and adenocarcinoma, as the distribution of each tumor was clearly separated. This case is the first report of a primary pulmonary collision tumor consisting of large cell carcinoma and adenocarcinoma.     

Pleomorphic carcinoma of the lung producing granulocyte colony-stimulating factor: report of a case

We herein report a case of acute respiratory distress syndrome (ARDS) that appeared to be related to a granulocyte colony-stimulating factor (G-CSF)-producing lung cancer. A 77-year-old man with arterial sclerotic obstruction (ASO) underwent reconstructive surgery of the left femoral artery. He developed ARDS on the 5th postoperative day, which resolved following mechanical ventilation with steroid pulse treatment. Four months later, he was admitted with a fever and right arm pain. Chest computed tomography showed a malignant lesion in the right apical lung, and percutaneous needle biopsy demonstrated adenocarcinoma. Laboratory data revealed neutrophilia with elevated serum G-CSF levels. He underwent a right upper lobectomy with chest wall resection, and administration of sivelestat sodium to treat his postoperative pre-acute lung injury state. Pathology revealed a G-CSF-producing pleomorphic carcinoma. Retrospectively, a tumor shadow was noted on chest X-ray at the time of ARDS just after ASO surgery. The relationship between an abnormal G-CSF level and ARDS was considered, and the implications are herein discussed.     

Pleomorphic carcinoma of the lung; report of a case

A 83-year-old male was referred to our hospital for further examination of abnormal shadow on chest radiography. Chest computed tomography (CT) showed a tumor mass in his right lung. Bronchoscopy brushing cytology revealed non-small cell lung carcinoma and right middle lobectomy was performed. Histological findings showed large cell carcinoma comprised of spindle cell component, finally diagnosing as pleomorphic carcinoma of the lung. Although he was diagnosed as pT2N0M0 (stage IA) after the operation, massive liver metastasis was found 7 months later. We report this case with references to the literatures on pleomorphic carcinoma of the lung.     

Multiple lung cancer with cavity; report of a case

A case of multiple lung cancer with cavity was reported. Chest X-ray and chest computed tomography (CT) showed two abnormal shadows with consolidation in the right S1 and S2b. The shadow in S2b had a cavity. Right upper lobectomy and right middle lobe partial resection was performed and the histopathological examination revealed adenocarcinoma. This case deserves attention of difficulty in differentially diagnosis on the chest X-ray and chest CT from pulmonary tuberculosis.     

A resected case of multiple lung cancers

A 78-year-old man was admitted to our hospital because of abnormal shadows on chest film. A 20 x 25 mm tumor shadow was found in the right lower lung field (S10) and a 5 x 10 mm tumor shadow in the right upper lung field (S2). Bronchoscopic curettage revealed squamous cell carcinoma from the specimen on the S10 and did not revealed malignant cells from the specimen on the S2. He was performed operation, squamous cell carcinoma in the S10 was removed by right lower lobectomy and nodule in the S2 was also removed by partial resection. Histological examination confirmed well-differentiated squamous cell carcinoma from the S10 and well-differentiated adenocarcinoma from the S2. He is healthy three year after operation.     

Resected early lung cancer with pulmonary aspergilloma.

Pulmonary aspergillosis and lung cancer rarely occur simultaneously. We report a 66-year-old man with a round shadow in the thin-wall cavity of the right upper lobe. Radiological findings and transbronchial biopsy revealed squamous cell carcinoma complicated by aspergilloma at the site. Right upper lobectomy suggested that early lung cancer arose from preexisting lung scars containing an aspergilloma.     

A case of metachronous lung cancer in which tumor developed within the different ipsilateral lobe over a short period of time and completion pneumonectomy was required]

A 51-year-old man underwent a middle-lower lobectomy for squamous cell carcinoma on February 8, 1996. In July, 1997, a computed tomography revealed a mass shadow in the right upper lung field. Completion pneumonectomy was performed. Histopathological examination showed poorly differentiated adenocarcinoma. This case was the shortest time to occurrence of second tumor in our metachronous lung cancer cases. We must always give attention to exist second primary lung cancer and double primary lung cancer after resection of primary lung cancer.     

Pleomorphic carcinoma of the lung; report of a case

Pleomorphic carcinoma is a rare primary lung cancer with a poor prognosis. We report a surgically treated case of pleomorphic carcinoma of the lung. An abnormal shadow was incidentally detected by computed tomography (CT) scan for an 80-year-old male. CT scan performed 1 month before the detection of tumor was normal. Right upper lobectomy with ND2a was performed after 5 months follow-up by CT scan because of the enlargement of the tumor. Histological examination showed numerous atypical spindle cells with massive necrosis, diagnosing as pleomorphic carcinoma. Only 2 months after operation, multiple metastases to the lung, chest wall, pleura, and small intestine were found.     

Pulmonary pleomorphic carcinoma with rapid and peculiar metastases; report of a case

A 54-year-old man was pointed out a mass shadow during treatment of suspected acute pyothorax. He was diagnosed as large cell carcinoma by transbronchial biopsy. Preoperative chemotherapy and right lower lobectomy were done. In pathological examination, he was diagnosed as pulmonary pleomorpic carcinoma. Postoperatively, he had rapid metastases of the pancreas, skin, muscle, brain and oral cavity. We reported a case of pulmonary pleomorphic carcinoma with rapid and peculiar metastases.     

Pleomorphic carcinoma of the lung; report of a case

A 66-year-old female complained of cough, and was referred to our hospital. Chest radiography and computed tomography (CT) showed a tumor mass near the right hilum and atelectasis of the middle lobe. Bronchoscopy revealed a whitish polypoid tumor obstructing the middle lobe bronchus. Histology by punch biopsy suggested adenocarcinoma Right upper and middle lobectomy was performed, due to the direct invasion of the tumor from the middle lobe to the upper lobe. Histological findings showed adenocarcinoma comprised of spindle cell component, finally diagnosing as pleomorphic carcinoma of the lung. After the operation, systemic chemotherapy, including paclitaxel and carboplatin was performed. About 42 months after operation, the patient died of multiple brain metastases.     

A case of primary lung adenocarcinoma with diffuse calcification in the tumor by psamoma bodies

A 78-year-old asymptomatic woman was referred to our department for the treatment of a right lung tumor. The patient had been suffering from rheumatoid arthritis and followed up in outpatient clinic. On March 6, 1995, abnormal shadow in the right upper lobe was pointed out by routine chest X-ray. Chest CT revealed calcification in the shadow, and benign lesion, such as old pulmonary tuberculosis, was suspected. During follow-up, the size of the shadow and calcification area in the shadow gradually increased. Malignancy was suspected based on the increasing size of the tumor. On July 12, 2000, video-assisted right upper lobectomy with hilar and mediastinal lymph node sampling was performed. Pathological examination revealed that the tumor was primary lung adenocarcinoma containing psamoma bodies in the tumor.     

Adrenal metastasis of lung adenocarcinoma with unusual sites of lymph node metastasis and concomitant renal cell carcinoma: a case report

A 58-year-old male presented to a clinic with general weakness. Right adrenal tumor was found by computed tomography and he was referred to our hospital. Imaging studies revealed right adrenal tumor (8 cm) with marked swelling of surrounding lymph nodes and synchronous left renal tumor (2 cm) that was weakly enhanced by contrast media. Needle biopsy of the left kidney proved to be clear cell type renal cell carcinoma (RCC) and the preoperative diagnosis was left RCC and right primary adrenal cancer with lymph node metastasis. We performed right adrenalectomy, lymph node dissection and left radical nephrectomy. Pathological findings of right adrenal tumor and lymph nodes were both metastatic adenocarcinoma, which was not consistent with RCC or adrenal-derived carcinoma. Then, we extensively reviewed preoperative radiological examinations and found a small lesion in the left upper lung. This lesion was attached to the mediastinal shadow and there was no obvious lymph node swelling around this lesion. According to pathological findings and an elevation of carcinoembryogenic antigen, the adrenal lesion was diagnosed as adrenal metastasis of lung adenocarcinoma.     

Pleomorphic carcinoma of the lung rapidly developed multiple metastases after surgery

Pleomorphic carcinoma of the lung is a type of carcinoma with spindle and/or giant cells with a poor diagnosis. A 73-year-old male was referred to our hospital because of the pulmonary tumor. Lung biopsy revealed that the tumor was poorly differentiated adenocarcinoma. No distant metastasis were observed by systemic examination. A right middle lobectomy with partial resection of the right upper lobe and lymph node dissection were performed, because the tumor (5.3 x 4.0 x 4.0 cm) was located in peripheral S' and invaded S3 via the interlobular space. Histological findings showed adenocarcinoma comprised of spindle cell components that reacted positively to epithelial membrane antigen (EMA) and no lymph node metastasis. Therefore, he was diagnosed with pleomorphic carcinoma of the lung, pT2N0M0, stage IB. But metastatic lesions newly appeared in the thoracic skin, the liver, the diaphragm, the bilateral adrenal glands, and the retroperitoneal space on the 30th postoperative day. He died of peritonitis and pleuritis on only 60 days after the operation.     

Pulmonary pleomorphic carcinoma; report of 2 cases

The 1st case was a 74-year-old male diagnosed as femoral neck fracture. Biopsy of the bone revealed metastatic adenocarcinoma. Chest computed tomography (CT) showed a mass lesion located in the right lower lobe. With a diagnosis of primary lung cancer (cT2N1M1), two-staged operation was performed. Pathological diagnosis was pleomorphic carcinoma [pT2N1M1 (OSS), stage IV]. He died 8 months after surgery due to metastasis to the thoracic spine. The 2nd case was a 80-year-old female who complained of lateral chest pain. Chest CT revealed a tumor in the right hilar region, which was diagnosed as adenocarcinoma by transbronchial lung biopsy. Only thoracic drainage was performed since metastases to the brain and the rib were demonstrated. She died 2 months after admission. Autopsy revealed pleomorphic carcinoma of the lung with metastasis to the brain, costa and mediastinal lymph nodes.     

Pleomorphic adenoma of the lung; report of a case

A 67-year-old woman was admitted because of an abnormal shadow on the chest X-ray film. Chest computed tomography (CT) film revealed a peripheral mass in the middle lower lobe of the lung. We performed open lung biopsy and diagnosed as a benign epithelial adenoma but not ruled out adenocarcinoma completely by intraoperative examination of frozen sections. We operated right middle lobectomy and mediastinal lymph nodes dissections. Histological examination confirmed pleomorphic adenoma. We examined salivary glands, but didn't find the focus of that. The patient had been well for three years postoperatively.     

Two surgical cases of synchronous double carcinoma of the lung and esophagus and review of 10 documented cases in Japan]

Synchronous double carcinoma of the lung and the esophagus is extremely rare disease. In Japan, 13 cases have reported by Abo and only 10 clinical cases have been documented so far. We describe two cases of synchronous double carcinoma of the lung and the esophagus. Case 1. A 74-year-old man was admitted to our hospital because of the abnormal shadow of the chest X-ray film. Left upper lobectomy was carried out for the lung carcinoma. Because of dysphagia after surgery, upper GI series and endoscopic biopsy were performed, and midesophageal carcinoma was revealed. Radical operation of the esophageal carcinoma was performed 2 months after the first operation. Pathological diagnosis of the lung tumor and the esophageal tumor were well differentiated adenocarcinoma and moderately differentiated squamous cell carcinoma respectively and both of them were early cancer. After 22 months of the second operation, he is doing well. Case 2. a 66-year-old man was operated on because of the esophageal carcinoma in other hospital. Abnormal shadow appeared in his X-ray film 10 months after operation. Although he received chemotherapy as metastatic lung cancer, bronchoscopic examination revealed it adenocarcinoma. We performed segmental lobectomy to him 17 months after the first operation. Pathological diagnosis was large cell carcinoma of the lung. He is also doing well 18 months after the second operation.     

Bronchioloalveolar carcinoma with acute respiratory failure due to hemoptysis; report of a case

A 69-year-old male was admitted to our hospital for hemoptysis and dyspnea. Because of his deteriorating respiratory distress, he was intubated and controlled by respirator for 3 days. He was diagnosed with adenocarcinoma of the lung by the sputum examination and chest computed tomography (CT) revealed an infiltration shadow in the peripheral superior ventral segment (S3) of the right upper lobe. He underwent right upper lobectomy with video-assisted thoracic surgery. Microscopic findings of the resected specimen measuring 10 x 10 x 7 cm revealed mucin-producing bronchioloalveolar carcinoma (BAC) with metastases in lymph nodes and the same lobe (S2b). We reported a rare case of BAC with hemoptysis.