SESSION TITLE: Cancer Student/Resident Case Report Posters II
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Pleomorphic Lung Carcinoma is a rare poorly differentiated non-small-cell lung carcinoma (NSCLC) containing at least 10% sarcomatoid tumor component, in the WHO histological classification of lung tumors, accounting only 0.1-1.0% of all primary lung cancers. It has a rapid progression and highly morbid course with limited treatment options. We present a case of Pleomorphic Lung Carcinoma (PLC) which rapidly progressed, leading to a fatal outcome.
CASE PRESENTATION: 68-year-old man came to ED with complaints of worsening of shortness of breath for one month. Patient denied any cough, hemoptysis, sputum production or weight loss. He had a 52 pack-year history of smoking. Physical examination revealed decrease air entry in left lower lung base which was consistent with chest roentgenogram finding. CT scan revealed bulky adenopathy of left hilum with extensive infiltrates throughout left lower lobe. Patient had Bronchoscopy which showed fungating mass partially obstructing left main bronchus. Biopsy showed spindle cells, giant cells and squamous cells consistent with PLC. Molecular studies showed that tumor was negative for EGFR. However, patient presented again after 3 weeks with worsening dyspnea. PET scan showed multiple hypermetabolic lymph nodes/masses in the left perihilar region and prevascular region. Repeat Bronchoscopy showed complete occlusion of left main stem bronchus. He was discharged home initially and was started on NSCLC chemotherapy. He received 2 cycles of chemotherapy before developing complications and was discharged under hospice care.
DISCUSSION: PLC is a rare and very aggressive tumor with high mortality because of lack of evidence-based clinical guidelines in literature for its management due to the rarity of the tumor. MIB-1 index is an indicator of tumor cell growth and proliferation. It is said to be significantly higher in sarcomatous elements than carcinomatous elements. Rapid progression of PLC is also said to come from its sarcomatous component of these tumors through activation of epithelial mesenchymal transition, which is also associated with tumor invasion and metastasis in various carcinomas. EGFR are strongly expressed in NSCLC. Expression of different EGFR mutations is related to the biphasic histological appearance in PLC. Therefore, EGFR inhibitors can be effective in shrinking tumors in such patients.
CONCLUSIONS: Early diagnosis and aggressive follow-up are most important factors in treatment of PLC. Knowledge of biological & clinical behavior of PLC is fundamental in approaching them aggressively.
Reference #1: Fujioka S, Nakamura H, Adachi Y, et al. Pleomorphic carcinoma of the lung in which the sarcomatous element grew rapidly: a case report. Ann Thorac Cardiovasc Surg 2009; 15: 111-4.
Reference #2: Shintani Y, Ohta M, Iwasaki T, Ikeda N, Tomita E, Kawahara K. Pulmonary pleomorphic carcinoma with rapid progression. Asian Cardiovasc Thorac Ann. 2013 Apr;21(2):231-4.
DISCLOSURE: The following authors have nothing to disclose: Muhammad Azam, Jandark Yuseif, Sarah Asghar, Eyoel Abebe, Shaiquel Jilani, Khalid Zakaria, Sarwan Kumar
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