Lung Cancer |

Pleomorphic Lung Carcinoma: A Notoriously Aggressive Tumor With Rapid Progression FREE TO VIEW

Muhammad Azam, MD; Jandark Yuseif, MD; Sarah Asghar, MD; Eyoel Abebe, MD; Shaiquel Jilani, MD; Khalid Zakaria, MD; Sarwan Kumar, MD
Author and Funding Information

Wayne State University - Crittenton, Rochester, MI

Chest. 2014;146(4_MeetingAbstracts):663A. doi:10.1378/chest.1992098
Text Size: A A A
Published online


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

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543