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      An Autopsy Case of Rapidly Progressing Spindle Cell Carcinoma of the Lung Accompanied with Intratumor Hemorrhage

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          Abstract

          Patient: Male, 74

          Final Diagnosis: Spindle cell carcinoma of the lung

          Symptoms: —

          Medication: Pemetrexed • carboplatin

          Clinical Procedure: Biopsy and autopsy

          Specialty: Oncology

          Objective:

          Rare disease

          Background:

          Spindle cell carcinoma (SPCC) of the lung is a subset of sarcomatoid carcinoma. Its clinical features are unclear because of its rarity. Here, we report an autopsy case of SPCC and review CT findings and chemotherapeutic regimens based on previous reports of this disease. To our knowledge, this is the first reported case of pemetrexed used to treat SPCC.

          Case Report:

          A 74-year-old Japanese male presented with dyspnea and contrast-enhanced computed tomography (CT) showed abundant left pleural effusion and a mass in lower lobe of the left lung. By the tumor biopsy, he was diagnosed for SPCC of the lung, cT3N0M1a, stage IV. The tumor was resistant to chemotherapy with carboplatin and pemetrexed, and rapidly progressed. Autopsy revealed abundant hemorrhage within the tumor, which apparently reflects a low-density area in CT.

          Conclusions:

          Present case and the accumulation of cases indicate that low-density areas in CT and rapid tumor progression may be common SPCC findings.

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          Most cited references21

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          Pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements: a clinicopathologic and immunohistochemical study of 75 cases.

          We collected 75 primary pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements to better define their clinical, histologic, and immunohistochemical profile. The patient's age ranged from 42 to 81 years (mean 65 years), and the male-to-female ratio was 9.7:1. Sixty-nine patients (92%) were smokers. Cough and hemoptysis were the most frequent presenting symptoms. Fifty-nine patients (65%) died of disease: only stage significantly predicts overall survival (p = 0.0273). Microscopically, based on the WHO criteria, 58 cases were classified as pleomorphic carcinoma (51 with an epithelial component, 7 composed exclusively of spindle and giant cells), 10 as spindle cell carcinoma, 3 as giant cell carcinoma, 3 as carcinosarcoma, and 1 as pulmonary blastoma. Immunohistochemically, in the tumors composed exclusively of spindle and/or giant cells, thyroid transcription factor-1 (TTF-1) and cytokeratin 7 were positive in 55% and 70% of the cases, respectively, whereas surfactant protein-A was always negative. In pleomorphic carcinomas with an epithelial component, cytokeratin 7, TTF-1, and surfactant protein-A were positive in the sarcomatoid component in 62.7%, 43.1%, and 5.9% of the cases, respectively, whereas they were always negative in the sarcomatous part of carcinosarcomas and blastoma. In the epithelial component of pleomorphic carcinomas, cytokeratin 7, TTF-1, and surfactant protein-A were positive in 76.4%, 58.8%, and 39.2% of the cases, respectively, whereas the same antibodies did not react with the epithelial component of carcinosarcomas; in the case of blastoma, the epithelial part of the tumor was positive for cytokeratin 7 and TTF-1, whereas it was negative for surfactant protein-A. Cytokeratin 20 was always negative. In our opinion, this study: 1) supports the metaplastic histogenetic theory for this group of tumors; 2) shows that cytokeratin 7 and TTF-1, but not surfactant protein-A, are useful immunohistochemical markers in this setting; 3) confirms that stage is at the moment the only significant prognostic parameter, as in conventional non-small cell lung carcinomas; and 4) shows that this group of tumors has a worse prognosis than conventional non-small cell lung carcinoma at surgically curable stages I, justifying their segregation as an independent histologic type in the WHO classification.
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            Sarcomatoid carcinoma of the lung: histologic criteria and common lesions in the differential diagnosis.

            Sarcomatoid carcinoma of the lung is a subset of poorly differentiated non-small cell lung cancers that are diagnostically challenging because they are uncommon, may reveal little of their parent cell of origin, and overlap morphologically with other anaplastic epithelioid and spindle cell tumors that can be primary in, or metastatic to, the lung and pleura. To review the current histologic classification and diagnostic criteria that identify the 5 subtypes of sarcomatoid carcinoma of the lung and to discuss the most common tumors in the differential diagnosis. Published classification systems from the World Health Organization and pertinent peer-reviewed articles indexed in PubMed (National Library of Medicine) form the basis of this review. Identification of sarcomatoid carcinoma of the lung requires knowledge of specific histologic criteria that define the 5 subgroups, targeted immunohistochemical studies, and correlation with chest imaging to assess distribution of disease and to avoid misdiagnosis.
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              Pleomorphic carcinoma of lung: comparison of CT features and pathologic findings.

              To retrospectively evaluate computed tomographic (CT) features of pleomorphic carcinoma of the lung and to compare these features with pathologic findings.
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                Author and article information

                Journal
                Am J Case Rep
                Am J Case Rep
                amjcaserep
                The American Journal of Case Reports
                International Scientific Literature, Inc.
                1941-5923
                2015
                12 November 2015
                : 16
                : 805-810
                Affiliations
                [1 ]Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
                [2 ]Department of Pathology and Host-Defense, Onco-Pathology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
                Author notes

                Authors’ Contribution:

                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Conflict of interest: None declared

                Corresponding Author: Junichiro Kida, e-mail: jkida@ 123456med.kagawa-u.ac.jp
                Article
                894443
                10.12659/AJCR.894443
                4648124
                26558362
                75caa0d7-c20e-4943-8578-2e1a92725372
                © Am J Case Rep, 2015

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License

                History
                : 23 April 2015
                : 17 June 2015
                Categories
                Articles

                tomography, x-ray computed,carcinoma,antineoplastic agents

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