SESSION TITLE: Bronchology/Interventional Procedures Cases II
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Monday, October 27, 2014 at 11:00 AM - 12:00 PM
INTRODUCTION: Pleomorphic (spindle) cell carcinoma (PC) is a rare primary pulmonary malignancy and is known for massive necrosis.
CASE PRESENTATION: A 71 year old male was recently diagnosed with non-small cell lung carcinoma and was undergoing radiation therapy. One month later he presented with worsening cough, inability to expectorate and stridor. He reported coughing out a piece of tissue a few days before admission. CT scan revealed interval progression of tumor within the inferior portion of the trachea, causing narrowing of the lumen and new near-complete right upper lobe collapse with debris/tumor within the segmental bronchi of the right lower lobe. He became hypoxemic and was admitted to the intensive care unit. During bronchoscopy, the lower tracheal tumor was ablated with forceps and basket tools. An 8 cm long mass molded in the shape of the airways was then extracted from the lower trachea. Procedure had minimal bleeding and no major complication. Patient experienced immediate improvement and did not require oxygen post procedure. He regained his functional capacity and was discharged home in 2 days. Pathology of the extracted specimen showed necrotic tissue containing poorly differentiated PC of lung with spindle cell features.
DISCUSSION: Our case presents a PC with massive necrosis which rapidly obstructed the major airways. PC of the lung is rare and is classified as a subtype of sarcomatoid carcinoma. This type of tumor shows concurrent presence of malignant epithelial and sarcomatoid spindle cell components and is susceptible to early distant metastasis. The disease is strongly associated with smoking. Survival rate is lower than that of other non-small cell lung carcinomas. Parenchymal masses may appear as cavities with marked central necrosis. There is a case report of a PC with endobronchial extension which did not recur after snare resection of the endobronchial tumor and lobectomy. Our patient had minimal symptoms until his major airways were occluded with massive debris from the necrotic tumor. His hypoxemia and other symptoms resolved soon after the removal of the mass from his airways.
CONCLUSIONS: Pleomorphic carcinoma is characterized by massive necrosis which may lead to large airway obstruction. Patients may develop symptoms due to airway obstruction by necrotic debris rather than progression of the tumor. The debris can potentially be removed via bronchoscopy.
Reference #1: Mochizuki T, et al. Pleomorphic carcinoma of the lung: clinicopathologic characteristics of 70 cases.Am J Surg Pathol. 2008
DISCLOSURE: The following authors have nothing to disclose: Ali Sadoughi, Kevin Hyman, Darshan Patel
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