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.     

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.     

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.     

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.     

Cavitating pleomorphic carcinoma of the lung; report of a case

We report a case of a previously healthy 76-year-old male with cavitating pleomorphic carcinoma of the lung. He was admitted because of an abnormal lung shadow on chest X-ray. Computed tomography (CT) showed a well-demarcated nodular shadow within thin-walled cavity in the right upper lobe. Because the lesion was revealed as adenocarcinoma by transbronchial lung biopsy, right upper lobectomy was performed. By histopathologic examination of the resected specimen, the nodule contained a component of spindle cell features and the cavity wall was composed of adenocarcinoma. The final diagnosis was pleomorphic carcinoma. Postoperative course has been uneventful for 12 months after surgery.     

Large cell neuroendocrine carcinoma of the lung; report of a case

Large cell neuroendocrine carcinoma (LCNEC) is a rare type of lung cancer and it has the least favorable prognosis. We describe our experience with a patient in whom LCNEC was diagnosed. A 65-year-old man who was pointed out abnormal shadow on a chest X-ray film in the health screening was admitted to the hospital. Chest X-ray film and computed tomography (CT) scan showed a 4 x 3 cm mass in the left-S2. Poorly differentiated adenocarcinoma of the left lung was suspected based on CT guided cytology. An upper lobectomy of the left lung and dessection of the mediastinal lymph nodes were performed. This tumor showed light microscopic and immunohistochemical evidences of neuroendocrine differentiation. Further it showed positive responses in neuronspecific enolase (NSE), synaptophysin, and chromogranin-A stainings. Pathological diagnosis was stage IB (pT2N0M0) LCNEC. There have been no findings of tumor recurrence 22 months after the operation.     

Pleomorphic carcinoma of the lung with high serum granulocyte colony stimulating factor, suggested of pulmonary abscess by preoperative radiology; report of a case

A 52-year-old man with a history of heavy smoking was hospitalized for evaluation of fever. Pulmonary abscess was initially suspected by computed tomography (CT) showing an ovoid, well-demarcated nodule of 61 mm in diameter with coarse calcification in S2a of the right lung. The patient was treated with antibiotics, but no improvement was seen in inflammatory reactions or lesion size. Marked leukocytosis and high level of granulocyte colony stimulating factor (G-CSF) was shown by laboratory examination. To improve patient condition and ensure correct diagnosis, right upper lobectomy of the lung was performed. Pleomorphic carcinoma of the lung was subsequently diagnosed. G-CSF producing tumor was suspected, since the normalization of serum G-CSF level followed by the improvement of both fever and inflammatory reaction was observed postoperatively. We also present herein a review of 22 Japanese cases of pleomorphic carcinoma producing G-CSF of the lung, characterized by leukocytosis.     

Pleomorphic carcinoma of the lung arising in a patient with Li-Fraumeni syndrome: Report of a case

We herein report the case of a patient with Li-Fraumeni syndrome (LFS) who developed lung pleomorphic carcinoma. A 28-year-old female patient with a family history of early-onset malignancies was diagnosed with lung carcinoma and treated by surgical resection. Histological examination revealed a heterogeneous tumor with epithelial and mesenchymal components. The final pathological diagnosis was pulmonary pleomorphic carcinoma. In this patient, a constitutional mutation at codon 213 in exon 6 of the p53 gene was identified in the peripheral lymphocytes and the resected tumor, and LFS was suspected. This mutation causes a nonsense mutation (Arg-to-Stop codon) that has been shown to attenuate p53 function. This is the first report of pulmonary pleomorphic carcinoma developing in an LFS patient, and may suggest a relationship between germline p53 mutation and carcinogenesis in pulmonary pleomorphic carcinoma.     

Duodenal metastasis from squamous cell carcinoma of the lung; report of a case

Metastatic carcinoma from primary lung cancer is usually recognized in the brain, adrenal glands, and bone. It is uncommon in the digestive system, particularly in the duodenum. We report a 63-year-old man who had undergone a left lower lobectomy for lung cancer. Anemia (Hb 6.9 g/dl) had been observed 2 months after surgery for primary lung cancer. Gastroduodenoscopy showed duodenal metastasis, and further examination demonstrated adrenal metastasis. Palliative treatment was selected and the patient died 5 months after surgery.     

Pleomorphic adenoma of the nasal septum: a case report

We report on a case of pleomorphic adenoma involving the nasal septum, in a caucasian woman aged 23, who presented with nasal obstruction and epistaxis. A swelling of the anterior part of the nasal septum was observed and a biopsy demonstrated the existence of a pleomorphic adenoma. CT scan and MRI investigation showed the lesion to be limited, and removal was therefore possible using an endonasal approach. No recurrence has been found after 22 months.     

Synchronous double carcinoma of the left lung and esophagus; report of a case

A 75-year-old man, who was followed for the atypical epithelium of the stomach, was diagnosed as esophageal carcinoma. Further examination revealed left lung tumor that was suspected of lung carcinoma. Radical operation of the esophageal carcinoma was performed. On 41st postoperative day, after open biopsy for the left lung tumor, left upper lobectomy was performed. Pathological diagnosis was moderately differentiated squamous cell carcinoma of the esophagus and well differentiated adenocarcinoma of the lung. Synchronous double carcinoma of the lung and the esophagus is rare.     

Pleomorphic lung cancer; a clinicopathologic study

Pulmonary pleomorphic carcinoma is a comparatively rare histologic type of lung carcinoma, and the incidence among all lung carcinomas has been reported to be 0.4%. We reported our experience with 8 patients who had been diagnosed as pulmonary pleomorphic carcinoma, and discussed clinicopathologically the preoperative diagnosis and treatment. In 2 of 8 patients, preoperative transbronchial lung biopsy revealed spindle cell component, highly suggesting pulmonary pleomorphic carcinoma. All patients underwent surgical treatment and 2 of then had incomplete resections because of intrathoracic disseminations or carcinomatous pericarditis. Pathological findings showed invasions into the surrounding thoracic organs such as the chest wall, pericardium, adjacent pulmonary lobe or mediastinal pleura in 5 cases, intrapulmonary metastasis of the same lobe in 3 and lymph node involvement in 3. Recurrence occurred in 6 patients immediately after the operation. Although the preoperative diagnosis of biphasic tumor such as pulmonary pleomorphic carcinoma is difficult, it is possible to suspect the diagnosis when sarcomatous components were detected by preoperative biopsy. The efficacy of chemotherapy and radiotherapy have not been established yet, and thus we would like to emphasize that surgery might be the treatment of choice.     

Combined large cell neuroendocrine carcinoma and squamous cell carcinoma of the lung; report of a case

An 80-year-old man was admitted to our hospital because a routine chest X-ray had revealed a nodular shadow in the right lower lung field. Transbronchial lung biopsy (TBLB) failed to give at definitive diagnosis, therefore open lung biopsy was performed because of suspected lung cancer. Rapid intraoperative pathological examination diagnosed the tumor as large cell carcinoma. However, bloody pleural effusion was classified as class V. It was judged difficult to perform a curative operation, so the operation was interrupted. Pathological diagnosis was combined large cell neuroendocrine carcinoma and squamous cell carcinoma. Pleurodesis was done, and the patient is under observation at 7 months after the operation.     

Pleomorphic carcinoma: report of a case with massive pleural effusion and asbestos particles.

Pleomorphic (spindle/giant cell) carcinoma (PC) is one subset of large cell carcinoma. It is well known that PC patients have a poor survival rate. This report describes a 68-year-old man with PC. The patient's tumor had a massive pleural effusion. A left lower lobectomy and partial resection of the left diaphragm, peritoneum, and parietal pleura were performed to remove the tumor. Numerous asbestos particles were found in the left lower lobe. This is the first reported case of PC which may have been caused by asbestos particles. Further investigation is needed into whether asbestos exposure causes PC.     

Collision cancer of squamous cell carcinoma and small cell carcinoma of the lung; report of a case

We report a rare case of a primary collision cancer in the lung consisting of squamous cell carcinoma and small cell carcinoma. A 65-year-old man with an abnormal shadow in the right S6 was diagnosed as squamous cell carcinoma by transbronchial lung biopsy. A right lower lobectomy with mediastinal lymph node dissection was performed. The pathological stage of squamous cell carcinoma was IIIA (T2N2M0). The other element diagnosed by pathological examination was small cell carcinoma of which pathological stage was IA (T1N0M0). Each element was clearly distinguished and touched each other. Following the operation, the patient received systemic chemotherapy against small cell carcinoma with cisplatin and irinotecan hydrochloride for 1 course, and cisplatin and etoposide for 3 courses. Since the prognosis of collision cancer is generally reported to be influenced by more advanced element of cancer, the prognosis of the present case is suspected to be dependent on the squamous cell carcinoma.     

肺多形性癌23例临床及病理分析

目的：探讨肺多形性癌（pleomorphic carcinoma,PC）的临床表现、手术方式、病理特点及预后。方法回顾性分析我院胸外科2010年1月～2014年3月收治的23例肺多形性癌患者的临床及病理资料。结果23例患者发病年龄为35～75岁,平均年龄（54±11）岁,其中男16例,女7例,男女比为2．3∶1。17例患者有既往大量吸烟史,吸烟指数为400～1200,平均（688±225）。患者常见首发症状为咳嗽、痰中带血或咯血。术前纤维支气管镜检查难以确诊。23例患者中行肺癌根治术22例,行肿块活检术1例。23例患者中含有恶性上皮成分和多形性成分19例,4例仅含多形性成分,多形性成分中可见 CK 阳性表达。23例患者均获得随访,最长生存时间为18个月,仍存活,中位生存期12个月。结论肺多形性癌好发于中老年男性吸烟患者,免疫组织化学检查有助于明确诊断,外科手术为主要治疗方法。肺多形性癌预后差。     

Pleomorphic xanthoastrocytoma (Kepes): a case report

A case of tumor to be diagnosed as pleomorphic xanthoastrocytoma (Kepes) is reported. This patient was a 34-year-old female with a 6-year history of TIA. Neurological examination on admission showed no abnormalities except for bilateral choked disc. Plain CT scan revealed a well-defined low density area with a small high density region in the right temporal lobe. The small high density region and a part of peripheral portion of low density area were moderately enhanced with contrast media. At operation there was a cyst containing xanthochromic fluid at 1.5 cm depth from the cerebral surface. Temporal lobectomy and subtotal removal of tumor (5gr) were performed. The patient received postoperative radiation therapy (5960 rad). She has been doing extremely well for these 5 years following craniotomy and has no deficits except for the left upper quadrant hemianopsia which appeared immediately after surgery. There cannot be observed any symptoms or signs suggesting tumor recurrence. Histologically the tumor cells displayed marked pleomorphism. However, either necrosis or mitosis were very hard to find. The tumor cells were surrounded by a dense network of reticulin fibers. Electron-microscopically the tumor cells were occasionally filled with glial fibrils, and lipid granules were seen. Immunoperoxidase technique revealed both glial fibrillary acidic protein (GFAP) and S-100 protein in the cytoplasm of tumor cells, suggesting of neuroectodermal origin. Although this patient is older than previously reported cases (age 3 to 32), the histological findings as well as the good postoperative course indicate that this case may fulfill the criteria of pleomorphic xanthoastrocytoma first proposed by Kepes et al.     

Ruptured lung abscess; report of a case

We reported an extremely rare case of ruptured lung abscess. A 60-year-old male was admitted to our hospital with sudden loss of consciousness. Thoracocentesis demonstrated pneumopyothorax. Right middle and lower lobectomy for ruptured abscess was performed. The patient remains well with no recurrent lung abscess 2 years postoperatively. This case emphasizes that ruptured lung abscess is a cause of pneumopyothorax.     

Patellar metastasis from a squamous carcinoma of the lung: a case report

Bone is a common site of metastasis from lung cancer. Metastasis to the patella, however, is rare. A 76-year-old man presented with knee pain caused by an isolated patellar metastasis from squamous cell carcinoma of the lung. Treatment was delayed secondary to delay in diagnosis. In cases of bone pain that are unexplained or out of proportion to a traumatic event, more extensive diagnostic studies should be done.