Surgical Management of Pleomorphic Lung Carcinoma With Left Atrial Invasion: Two Cases Including One With Cerebral Artery Metastasis.

Invited Commentary

Extensive Invasion of the Left Atrium by Lung Cancer

Non-small cell lung carcinomas with a minor sarcomatoid component and pleomorphic carcinomas are associated with high expression of programmed death ligand 1

Pleomorphic carcinoma is one of the most difficult non-small cell lung cancers to treat with cytotoxic agents. Early recurrence after pulmonary resection is common, and the prognosis is poor. Herein, we report a case of pleomorphic carcinoma effectively treated via molecular targeting. An 80-year-old man relapsed within six months of undergoing left lower lobectomy for pathological stage IIB pleomorphic carcinoma. The initial treatment consisted of carboplatin, pemetrexed, and pembrolizumab, together with opioids (for severe pain due to pleuritis carcinomatosis and bone metastasis) and home oxygen therapy. Following the detection of a BRAF mutation (V600E) via whole-genome sequencing, the treatment was switched to dabrafenib (a BRAF inhibitor) and trametinib (a MEK inhibitor). One month later, the previously observed pleural effusion disappeared, and the radiological pulmonary findings were normal. The patient's pain diminished, the opioid dose was reduced, and home oxygen therapy was discontinued. This condition was maintained for approximately nine months; however, the patient died 11 months after treatment. Although controlling pulmonary pleomorphic carcinoma is challenging, the present case illustrates the effectiveness of BRAF and MEK inhibitors in cases with BRAF mutations, even those involving octogenarians.

Resuscitation After Prolonged Cardiac Arrest: Role of Cardiopulmonary Bypass and Systemic Hyperkalemia

Lung Cancer Staging and the Home Insurance Building Constructed in 1884–1885

MTE 03.01 Do Extended Resections Improve T4 Lung Cancer Outcomes?

Left Atrial Reduction Plasty: A Novel Technique

Aim of the studyPulmonary pleomorphic carcinoma (PPC) of the lung is a subset of poorly differentiated non-small cell lung cancers (NSCLCs). Because of its rarity, information on epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene (KRAS) mutations is controversial and sparse. The aim was to investigate the two key oncogenes’ characteristics and their correlation with clinical variables.Material and methodsWe retrospectively screened 110 paraffin-embedded surgically resected specimens from patients with PPC. Of these, follow-up information was available for 48 patients. We then successfully analyzed 70 PPC samples and examined EGFR and KRAS mutation status by direct sequencing. The findings were correlated with a control group of patients with other NSCLCs.ResultsIn our department, PPC comprised about 1.57% of surgical resected cases (110/6990). 37.4% of patients smoked. EGFR mutations were detected in 11 cases (15.7%), with a significantly higher frequency in women than men (p = 0.011). KRAS mutations were detected in 10 cases (14.3%) and were more often found at age 65 or older (p = 0.02). Of interest, in PPC, all KRAS mutations occurred in never smokers. Also, most never smokers have transversion mutations (G→T) in PPCs and other NSCLCs.ConclusionsOur results demonstrated a similar EGFR and KRAS mutation rate in Chinese PPC patients. EGFR tyrosine kinase inhibitors may be a treatment option for PPCs with EGFR mutations. Of note, EGFR mutations in PPC were commonly identified in women; therefore women should be high-priority candidates for mutation screening.

MET exon 14 skipping mutation in triple-negative pulmonary adenocarcinomas and pleomorphic carcinomas: An analysis of intratumoral MET status heterogeneity and clinicopathological characteristics

The study was carried out to assess the short and long-term outcome of patients with non-small cell lung cancer infiltrating the left atrium treated by surgery. We retrospectively collected the hospital files of twenty-three consecutive patients operated on between 1982 and 2001 in two units of Thoracic Surgery. Four patients received an induction regimen. Fourteen right pneumonectomies, 8 left pneumonectomies and 1 right inferior lobectomy were performed. No cardiopulmonary bypass was employed. In all patients the diagnosis of T4 atrial invasion was confirmed by pathological examination. A complete resection was achieved in nineteen patients (83%). With respect to nodal staging, there were 13 N0, 5 N1 and 4 N2 cases, respectively. Two deaths occurred during the one month postoperative period (9%). Three patients had postoperative atrial fibrillation. Two other patients had postpneumonectomy empyema without bronchopleural fistula and recovered, one after thoracoscopic debridement and the second after open window thoracostomy. Follow-up was completed on September 2002; only one patient was lost to follow-up. Median survival, excluding the perioperative mortality, was 20 months (range 4 - 62 months). The survival rate, calculated with the Kaplan-Meier method, was estimated as 63% at 1 year, 2 % at 3 years and 10% at 5 years. Using a Cox model analysis, lymph node stage and completeness of resection were not independent prognostic factors. In cases of NSCLC with left atrial invasion complete resection is technically feasible in most instances without cardiopulmonary bypass. The acceptable operative risk and the encouraging long-term survival observed in this series suggest that NSCLC invading the left atrium should not be systematically considered as a definitive contraindication to surgery.

Une tumeur primitive rare du poumon : le carcinome pléomorphe

Le carcinome pléomorphe du poumon. À propos d’un cas

5 - Surgically Resected Pleomorphic Lung Carcinoma: Computed Tomography

Patient: Male, 69Final Diagnosis: Lung cancerSymptoms: AnemiaMedication: —Clinical Procedure: LobectomySpecialty: OncologyObjective:Rare diseaseBackground:Recently, synchronous multiple lung cancer (SMPLC) has sometimes been detected as a result of improved radiological imaging, although the occurrence of SPMLC is still rare. To the best of our knowledge, there have been no reported cases of with synchronous double primary lung cancer presenting with pleomorphic carcinoma and adenocarcinoma. We herein report such a case.Case Report:A 64-year-old male was referred to our institution for an abnormal shadow in the apex of the left lung in April 2012. CT revealed 2 nodules that measured 15 mm in the left S1+2b and 20 mm in the left S3c. We suspected that the lesions were malignant, although the diagnosis could not be confirmed by transbronchial lung biopsy of the lesions. Therefore, we performed the left upper lobectomy. The results of the pathological examination of the nodule in S3c showed adenocarcinoma of pT1aN0M0, stage IA. The nodule in S1+2b was found to be pleomorphic carcinoma, pT1aN0M0, stage IA. In November 2012, the patient underwent an esophagogastroduodenoscopy because of anemia. The image findings showed a gastric ulcer on the greater curvature of his stomach. The pathological examination of the biopsy specimen from the ulcer revealed the metastatic cancer from pleomorphic carcinoma. In addition, abdominal CT revealed bilateral adrenal metastasis. Although the patient received chemotherapy, it was not effective. It was difficult to continue the chemotherapy because his performance status worsened. He died in May 2013.Conclusions:The present case was associated with a poor prognosis, even though the pathological stage of each tumor was stage IA. The prognosis of SMPLC may be associated with the histologic type, although the prognosis of SMPLC remains unclear due to its rarity.