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Lung Cancer |

A Case of Rare Lung Tumor Causing Rapid Recurrent Endobronchial Obstruction

Jonelle Raphael*, MD; Ryan Chua, MD; Anuj Mittal, MD; Hisashi Tsukada, MD; Bijan Sadrnoori, MD; Samaan Rafeq, MD
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Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, MA


Chest. 2012;142(4_MeetingAbstracts):571A. doi:10.1378/chest.1388626
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Abstract

SESSION TYPE: Cancer Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Pleomorphic giant cell carcinoma of the lung is a rare and aggressive tumor. We describe a case of rapid regrowth of an endobronchial tumor after 1 week of endobronchial excision.

CASE PRESENTATION: A 61 year old female active smoker presented with 1 week of progressive dyspnea, fever and non productive cough. Breath sounds were decreased in the right lower chest with dullness to percussion. There was marked leukocytosis. CT scan revealed large right hilar mass, pleural effusion and a filling defect in the right mainstem bronchus. Pleural fluid was negative for malignant cells. Rigid bronchoscopy showed a large endobronchial mass in the distal trachea arising from the right upper lobe causing near complete occlusion of the trachea. The tumor was excised using electrocautery snare and rigid forceps. Pathology showed pleomorphic giant cell carcinoma of the lung. The patient’s symptoms improved; however, leucocytosis and fever persisted despite antibiotics. Cultures were negative. One week later, she developed worsening dyspnea and CXR revealed complete right lung collapse. Repeat rigid bronchoscopy showed regrowth of the right mainstem endobronchial mass which was again excised. The extent of disease and patient’s poor functional status deemed her inoperable. Acute renal failure precluded the use of adjuvant chemotherapy. Palliative radiation therapy was started; however, repeat imaging 3 weeks later showed progression of disease.

DISCUSSION: Pleomorphic giant cell carcinoma of the lung is a subtype of sarcomatoid carcinoma and is classified as a poorly-differentiated, non-small cell lung carcinoma containing greater than 10% giant cells. It constitutes 0.3-1.3% of all malignancies of the lung. The median age of diagnosis is 60 -70 years. There is a strong male predominance, an association with heavy cigarette smoking and upper lobe predominance. Persistent leukocytosis seen in our patient has been described in one case of pleomorphic giant cell tumor producing IL6. More than 50% of patients present with metastatic disease. Median survival is 8-10 months. Standard Chemotherapy has very poor response rates.

CONCLUSIONS: Pleomorphic giant cell lung carcinoma is a highly aggressive tumor. When it extends to the central airways, endobronchial tumor excision can be a palliative option; however, its effects appear to be short lived with need for repeat excision.

1) Travis WD, Sarcomatoid neoplasms of the lung and pleura. Arch Path Lab Med 2010 Nov; 134(11):1645-58

2) Yasutomi Higashikuni et al Interleukin-6-producing Giant Cell Carcinoma of the Lung with Multicentric Castleman’s Disease-like Presentation Intern Med 2007;46(10):669-73

DISCLOSURE: The following authors have nothing to disclose: Jonelle Raphael, Ryan Chua, Anuj Mittal, Hisashi Tsukada, Bijan Sadrnoori, Samaan Rafeq

No Product/Research Disclosure Information

Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, MA

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