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      Autopsy case of a patient with rapidly progressive combined small‐cell lung carcinoma with spindle‐shaped cell tumor

      case-report

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          Abstract

          A 69‐year‐old Japanese man visited our hospital because of worsening shortness of breath. His chest computed tomography (CT) showed a giant left lung mass with a massive left pleural effusion. He could not be treated with chemotherapy and eventually died from a rapidly progressive tumor. He was diagnosed with combined small cell lung carcinoma (C‐SCLC) with spindle‐shaped cell tumor at autopsy. C‐SCLC is characterized by pathologically concurrent SCLC and adenocarcinoma or squamous cell carcinoma, or rarely, spindle‐shaped cell tumor. The clinical course of C‐SCLC with spindle‐shaped cell tumor has not previously been determined. Our patient's tumor increased by 2.59‐fold in 20 days. The combination of C‐SCLC with spindle‐shaped cell tumor suggested rapid progression and a poor prognosis.

          Abstract

          We present a rare case of C‐SCLC with three different components (SCLC, adenocarcinoma, and a spindle‐shaped cell tumor). Two thoracenteses did not allow for a diagnosis, but thoracoscopic pleural biopsy showed features of SCLC (a), adenocarcinoma (b), and a spindle‐shaped cell tumor (c). Autopsy led to a diagnosis of C‐SCLC including those three tumor components. Our patient's tumor increased by 2.59‐fold in size in 20 days, suggesting that the combination of C‐SCLC with a spindle‐shaped cell tumor caused rapid progression and a poor prognosis. Physicians should be aware of the proper diagnosis of C‐SCLC including spindle‐shaped cell tumors in patients with rapidly progressive lung cancer in addition to SCLC.

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          Most cited references18

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          Pleomorphic (spindle/giant cell) carcinoma of the lung. A clinicopathologic correlation of 78 cases.

          The authors undertook this study to define the clinical and histologic characteristics of spindle and giant cell carcinomas of the lung and the survival and prognostic features of these tumors. Seventy-eight cases of pleomorphic (spindle and/or giant cell) carcinoma of the lung were studied by light microscopy and immunohistochemistry to establish clinical, gross, and histologic parameters. Follow-up information was obtained from contributing physicians and analyzed by statistical means to determine prognostically significant parameters. The patient population consisted of 57 men and 21 women (male to female ratio, 2.7 to 1) between the ages of 35 and 83 years (mean, 62 years). Clinically, 58 patients (80%) presented with symptoms including thoracic pain, cough, and hemoptysis, whereas 14 (18%) were asymptomatic. At the time of diagnosis, 41% of the patients had clinical Stage I lesions, 6% Stage II lesions, 39% Stage III lesions, and 12% Stage IV lesions. Histologically, foci of squamous cell carcinoma were present in 8% of the tumors, large cell carcinoma in 25%, and adenocarcinoma in 45%. The remaining 22% of neoplasms were completely spindle and/or giant cell carcinomas. Spindle and giant cell carcinomas were found together in 38% of the patients. In the 69 patients for whom follow-up information was obtained, 53 (77%) died within 7 days to 6 years after diagnosis, with a 23-month mean survival (median, 10 months) (Kaplan-Meier method). There was a significant shortening of survival for patients with tumor size greater than 5 cm, clinical stage greater than 1, and lymph node involvement. The presence of nodal metastases was the most significant single prognostic factor, whereas the presence of squamous or adenocarcinomatous differentiation did not have an impact on length of survival. The frequency with which spindle and giant cell carcinomas are found together, their frequent association with other histologic subtypes of lung carcinoma, and the similar clinicopathologic features of these tumors suggest that they are best regarded as one type of lung cancer called pleomorphic carcinoma.
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            Small cell lung carcinoma (SCLC): a clinicopathologic study of 100 cases with surgical specimens.

            Separation of small cell lung carcinoma (SCLC) from nonsmall cell lung carcinoma (NSCLC) is a critical distinction to be made in the diagnosis of lung cancer. However, the diagnosis of SCLC is most commonly made on small biopsies and cytologic specimens, and practicing pathologists may not be familiar with all its morphologic guises and frequent combination with NSCLC elements, which may be seen in larger specimens. Following the most recent WHO classification of lung tumors and with the hope of identifying prognostic markers, we examined in detail the histology of 100 surgical biopsies or resections with a diagnosis of SCLC from the AFIP and pathology panel of the International Association for the Study of Lung Cancer (IASLC). Multiple clinical and histologic features were studied by Kaplan-Meier analysis. Neuroendocrine architectural patterns, including nested and trabecular growth, with peripheral palisading and rosette formation were common in SCLC. Necrosis and apoptotic debris was prominent in all cases, but crush artifact was infrequent. Cell size in surgical biopsy specimens appears larger than in bronchoscopic biopsy specimens and occasional cells may show prominent nucleoli and vesicular nuclear chromatin, but this does not preclude the diagnosis of SCLC. A high percentage of cases (28%) showed combinations with NSCLC, with large cell carcinoma the most common, followed by adenocarcinoma and squamous cell carcinoma. Because of the frequency of a few scattered large cells in SCLC, we arbitrarily recommend that at least 10% of the tumor show large cell carcinoma before subclassification as combined SC/LC. However, combined SCLC is easily recognized if the additional component consists of other NSCLC subtypes such as adenocarcinoma or squamous cell carcinoma, so no percentage requirement is needed. Stage remained the only predictor of prognosis.
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              Combined SCLC clinical and pathologic characteristics.

              Despite the well characterized clinical course of 'pure' SCLC, there have not been many data on combined SCLC, ie, tumors, which contain both small-cell and non-small-cell components. We analyzed 1628 consecutive cases of lung cancer (1200 NSCLC, 428 SCLC) at our institution over the past decade. We identified 22 patients with C-SCLC. The pathologic and clinical characteristics of these patients were reviewed. Survival analysis was performed and prognostic factors were assessed. These data were compared with the results obtained from our 406 pure SCLC patients who presented during the same time period. The most common pathology was combined small-cell and large-cell with 16 cases followed by combined small- and squamous-cell carcinoma (3 cases), 2 cases of small-cell and nonspecified NSCLC, and 1 case of small cell and adenocarcinoma. Overall survival was significantly higher in C-SCLC patients compared with pure SCLC (median 15 vs. 10.8 months; P = .035). Surgery was significantly more common in this group of patients (45% vs. 3% in the pure small cell group; P < .0001). No difference in overall survival was observed in patients with C-SCLC and patients with pure SCLC, that did not receive surgery (P = .64). Patients with combined SCLC carry a better prognosis than those with pure small-cell variety and are more likely to undergo surgery. Copyright © 2013 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                yamasaki@med.uoeh-u.ac.jp
                Journal
                Thorac Cancer
                Thorac Cancer
                10.1111/(ISSN)1759-7714
                TCA
                Thoracic Cancer
                John Wiley & Sons Australia, Ltd (Melbourne )
                1759-7706
                1759-7714
                28 June 2022
                August 2022
                : 13
                : 15 ( doiID: 10.1111/tca.v13.15 )
                : 2279-2282
                Affiliations
                [ 1 ] Department of Respiratory Medicine University of Occupational and Environmental Health Kitakyushu City Japan
                Author notes
                [*] [* ] Correspondence

                Kei Yamasaki,

                Department of Respiratory Medicine,

                University of Occupational and Environmental Health, Japan,

                1‐1 Iseigaoka, Yahatanishiku, Kitakyushu City,

                Fukuoka, 807‐8555, Japan.

                Email: yamasaki@ 123456med.uoeh-u.ac.jp

                Article
                TCA14559
                10.1111/1759-7714.14559
                9346181
                35762505
                97380b79-0ee8-4f67-974b-66d5a581ef8a
                © 2022 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                Page count
                Figures: 4, Tables: 2, Pages: 4, Words: 2566
                Product
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                August 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:03.08.2022

                adenocarcinoma,combined small‐cell lung carcinoma,spindle‐shaped cell tumor

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