Case Of Pulmonary Pleomorphic Carcinoma Research Articles

A Case of Pulmonary Pleomorphic Carcinoma with an Epidermal Growth Factor Receptor Gene Exon 20 Insertion Mutation Treated with Osimertinib

A Case of Pulmonary Pleomorphic Carcinoma with an Epidermal Growth Factor Receptor Gene Exon 20 Insertion Mutation Treated with Osimertinib

Assessment of surgically resected cases of pulmonary pleomorphic carcinoma

Assessment of surgically resected cases of pulmonary pleomorphic carcinoma

EP1.09-09 Surgical Cases of Pulmonary Pleomorphic Carcinoma at Our Institution

EP1.09-09 Surgical Cases of Pulmonary Pleomorphic Carcinoma at Our Institution

EP1.08-06 Postoperative Oligo-Recurrence of Non-Small Cell Lung Cancer

Postoperative recurrences of non-small cell lung cancer (NSCLC) are usually disseminated and systemic. The concept of oligo-recurrence, defined as a small number of new lesions at a distant site theoretically curable by local therapy, has recently been proposed for several cancers. The aim of this study was to clarify clinical features and outcomes of patients with postoperative oligo-recurrence of NSCLC. From 364 patients who underwent resection for NSCLC between January 2008 and December 2017 at our hospital. A total of 43 patients who developed recurrence were included in this study. Oligo-recurrence was defined as 1-2 loco-regional or distant recurrence lesions restricted to a single organ. Other recurrences were classified as poly-recurrence. Local therapy included surgery, stereotactic radiotherapy and radiotherapy. Oligo-recurrence was identified in 12 (27.9%) patients, mainly as a solitary recurrence (n=11, 91.7%) in regional lymph nodes (n=1), surgical stump (n=2), brain (n=5), lung (n=1), bone (n=2) and liver (n=1). Primary tumor histopathological types included 9 cases of adenocarcinoma, one case of squamous cell carcinoma, one case of pulmonary pleomorphic carcinoma and one case of large cell neuroendocrine carcinoma.The patients with oligo-recurrence had a longer time to recurrence than those with poly-recurrence (median: 23.5 months, 11.0 months). A case of mediastinal lymph node recurrence was performed radiation therapy. A case of surgical stump recurrence underwent lobectomy and other case was performed concurrent chemo-radiotherapy. 4 case of brain metastasis were underwent tumor resection and were performed stereotactic radiotherapy, one case of brain metastasis was performed stereotactic radiotherapy only. A case of lung metastasis underwent wedge resection and was used EGFR-TKI. A case of bone recurrence was performed radiation therapy and was used EGFR-TKI, other case was performed concurrent chemo-radiotherapy. A case of liver metastasis underwent tumor resection. 7 of 12 cases confirmed re-recurrence after local therapy. But 9 patients were alive between 30.4 and 110.0 months after local therapy, whereas three of 5 brain metastatic patients died between 24.9 and 71.8 months. The 5 year overall survival rates after local therapy were 81.5%. The presence of oligo-recurrence can predict a favorable prognosis in patients with NSCLC treated with aggressive local therapy.

Two Cases of Pulmonary Pleomorphic Carcinoma Treated with Pembrolizumab

Two Cases of Pulmonary Pleomorphic Carcinoma Treated with Pembrolizumab

A Case of Pulmonary Pleomorphic Carcinoma Discovered During Optional Low-dose Computed Tomography Screening and Resected at the Early Stage

A Case of Pulmonary Pleomorphic Carcinoma Discovered During Optional Low-dose Computed Tomography Screening and Resected at the Early Stage

A Case of Pulmonary Pleomorphic Carcinoma That Could Hardly Be Distinguished from a Malignant Pleural Mesothelioma

A Case of Pulmonary Pleomorphic Carcinoma That Could Hardly Be Distinguished from a Malignant Pleural Mesothelioma

A Case of Pulmonary Pleomorphic Carcinoma Accompanied by Pulmonary Hypertrophic Osteoarthropathy

A Case of Pulmonary Pleomorphic Carcinoma Accompanied by Pulmonary Hypertrophic Osteoarthropathy

カルボプラチン，パクリタキセル，ベバシズマブ併用療法が奏効したhumoral hypercalcemia of malignancy合併肺多形癌の1例

カルボプラチン，パクリタキセル，ベバシズマブ併用療法が奏効したhumoral hypercalcemia of malignancy合併肺多形癌の1例

急激な転帰を辿った肺多形癌の1例

肺多形癌には根治術後でも早期に再発や転移を来し，予後不良な転帰を辿る症例がある．症例は63歳，男性．心不全と糖尿病性神経障害による腎後性腎不全で入院中，胸部CTで右肺下葉S9に最大径33 mmの腫瘍を認めた．2ヵ月後，画像検査で腫瘍径は56 mmに増大していたが，遠隔転移を疑う病変を認めないため，右肺下葉切除術＋ND2aを施行し，肺多形癌pT2bN0M0 stage IIAと診断した．術後31病日よりテガフール・ウラシル配合剤を開始したが，術後49病日に腰背部痛と，胸腹部CTで腹水と腹膜に多発小結節を認めた．内視鏡検査で多発胃腫瘍を認め，病理組織検査で肺多形癌の胃転移と腹膜播種による癌性腹膜炎と診断したが，術後63病日に死亡した．本症例は，腫瘍倍加時間が28日と極めて短いのが特徴的であるが，このような症例では，術後早期に再発を来し，不幸な転帰を辿る可能性があることを認識しておく必要がある．

無治療で陰影の縮小を認めた肺多形癌の1例

背景．肺多形癌は血痰や喀血を認めることが多い．症例．46歳女性．約3週間前から血痰が持続するため近医を受診し，右S1の嚢胞に接して結節状陰影とその周囲に非区域性の浸潤影を認めたため当院に紹介された．気管支鏡検査時には右上葉の陰影は嚢胞周囲に壁肥厚を残して縮小しており，擦過細胞診のみ施行したが悪性細胞は検出されなかった．2ヶ月後に再度血痰が出現し，CTでは右S1の嚢胞の壁肥厚が増悪していた．右B1aより経気管支肺生検を施行して肺扁平上皮癌と診断し，その後施行したFDG-PET/CTでは右上葉の嚢胞の壁肥厚に一致して集積を認めた．全身検索の結果，cT1bN0M0，stage IAと診断し右肺上葉切除術を施行した．腫瘍は上皮性腫瘍の他に，紡錘細胞や巨細胞を特徴とする肉腫様成分を多数認め，肺多形癌と診断した．また壊死組織が多くの血管を巻き込み出血領域が拡大，吸収を繰り返したため無治療で陰影の縮小を認めたと考えられた．結語．肺多形癌は血管新生に富み，易出血性であることから，陰影が自然縮小しても悪性の可能性を考慮し積極的に診断を進めるべきであると考える．

肺多形癌切除例27例の臨床的検討

肺多形癌切除例27例の臨床的検討

Successful treatment of two consecutive cases of pulmonary pleomorphic carcinoma with platinum chemotherapy.

Pulmonary pleomorphic carcinoma (PPC) is a rare pulmonary malignant tumor that has a more aggressive clinical course and a poorer prognosis compared with non-small cell lung cancer (NSCLC) due to its resistance to chemotherapy and radiotherapy. In patients with advanced or relapsed PPC, it has been reported that the response rate to chemotherapy regimens known to be effective in patients with NSCLC is only 0-17%. The present study reports the cases of two consecutive patients with advanced PPC who exhibited marked responses to chemotherapy with carboplatin plus paclitaxel chemotherapy and long-term survival without tumor progression. This suggests that carboplatin plus paclitaxel chemotherapy is a good option for the treatment of advanced PPC.

小腸切除組織で多形癌が疑われた肺癌小腸多発転移の1例

背景．肺多形癌は紡錘形細胞または巨細胞からなる肉腫様成分を含む稀な低分化な癌で，診断に難渋することが多く，その予後は不良である．症例．73歳男性．発熱を主訴に近医を受診し，左上葉の腫瘤と腹部腫瘤を指摘され当院に紹介された．左上葉腫瘤に対して経気管支的肺生検を行い，癌腫が証明されたが，組織型の確定は困難であった．さらに腹部腫瘤は小腸内視鏡生検にて低分化癌と診断され，免疫染色パターンから肺原発が疑われた．腸閉塞や穿孔を来す危険性が高いと判断し，小腸切除を行った．手術所見では計3か所に小腸腫瘍を認め，うち1か所は既に横行結腸に穿通し，さらに空腸動脈浸潤，腹壁・膀胱浸潤も伴っていた．腫瘍は，紡錐形細胞，巨細胞を特徴とする肉腫様成分とともに低分化な上皮性腫瘍を混じた多形癌であった．結論．本症例は原発巣の肺生検組織のみでは診断が困難であった．抗生剤不応性の遷延性発熱，炎症反応の上昇を伴った消化管転移を認める症例の鑑別には肺多形癌を考慮すべきで，病状が重篤化する前に積極的に転移病巣の切除を検討すべきである．

A Case of Pulmonary Pleomorphic Carcinoma Complicated by Lung Abscess and Organizing Pneumonia, Which Had Been Interpreted as Medically-intractable Severe Abscess and Pneumonia

A Case of Pulmonary Pleomorphic Carcinoma Complicated by Lung Abscess and Organizing Pneumonia, Which Had Been Interpreted as Medically-intractable Severe Abscess and Pneumonia

Surgical treatment for pulmonary pleomorphic carcinoma: A retrospective study of 60 patients.

Pleomorphic carcinoma is a rare epithelial malignant tumor. Because the clinical characteristics and behavior of the disease remain unclear, we investigated the clinicopathological findings and prognosis of 60 patients with pleomorphic carcinoma. The clinicopathological characteristics of 60 cases of pulmonary pleomorphic carcinoma identified between 1999 and 2011 were studied. Of these, 55 patients had peripheral disease and five had central disease. The tumor size in all patients was 1-9.5 cm (mean, 5.8 ± 4.5 cm), while 30 had lesions with a diameter larger than 5 cm. All patients underwent pulmonary resection. There were no in-hospital deaths. The three and five year survival rates of all patients were 47.2% and 25.6%, respectively. The three and five year survival rates were 57.3% and 32.5% for N0 patients, and 25.4% and 17.1% for N1-2 patients, respectively. Overall survival was significantly different between the radical resection and incomplete resection groups. Multivariate Cox regression analyses of overall survival for all 60 patients indicated that radical resection (P= 0.041), tumor node metastasis (TNM) stage (P= 0.044), and nodal status (P= 0.029) were significant independent prognostic factors. Pleomorphic carcinoma is a rare type of lung cancer. In our study, pleomorphic carcinoma of the lung was often found as a peripherally located large mass and was associated with a poor prognosis. Radical resection, TNM stage and nodal status were significant independent prognostic factors.

A Case of Pulmonary Pleomorphic Carcinoma Treated with Concurrent Chemoradiotherapy Followed by Successful Tumor Resection

背景．肺原発多形癌は，術前診断が困難で，標準的治療も確立されていない予後不良な疾患である．症例．43歳女性.2007年7月右腋窩から背部への疼痛を主訴に近医受診．胸部異常陰影を指摘され当院紹介受診となった.画像所見より胸壁浸潤を伴う肺悪性腫瘍を疑い経気管支生検を施行．巨細胞を含む癌細胞からなる肉腫様癌の可能性があるとの病理組織所見を得た.全身検索では転移を認めず，胸壁浸潤を伴う肺原発多形癌（cT3N0M0，stage IIB）と術前診断し，CDDP（80 mg/m2 day 1）+VNR（20 mg/m2 days 1，8） 3コースと同時放射線治療40 Gy/20 Frを行った．腫瘍はほぼ消失し治療効果はPRと判定した．手術は右上葉切除+第3～6肋骨合併切除+ND2aとComposix Meshによる胸壁再建を行った.術後病理組織所見では第4肋骨と第4肋間筋および同部の肥厚した胸膜内とその胸膜直下の肺内に残存する腫瘍組織を認めた．術後経過は良好で術後10日目に退院，術後2年3ヶ月現在無再発生存中である．結論．術前同時併用化学放射線療法と外科切除が有効であった1例を報告した．予後不良な肺原発多形癌であるが，集学的治療の確立により予後の改善が期待できると考える．

Pleomorphic carcinoma of the lung: A case report with immunohistochemical studies

Because incidence and immunohistochemical features of pulmonary pleomorphic carcinoma (PC) are unclear, the author retrospectively surveyed and re-examined the archival 718 lung malignancy samples in our laboratory. As the results, one case of pulmonary PC was found; thus the incidence of pulmonary PC was 0.14% of all lung malignancies. A 67-year-old woman with asthma was found to have a rapidly growing tumor in the peripheral lower lobe of right lung at a private clinic, and was referred to our hospital. She was a non-smoker. Imaging modalities showed a cystic tumor, and clinical diagnosis was bronchogenic cyst. Right lower lobectomy was performed. The patient is now alive without tumors six years after the operation. Grossly, the tumor was well-defined white tumor with necrosis. The tumor measured 5 × 4 × 5 cm. Histologically, the tumor was pulmonary PC consisting of malignant spindle and giant cells with focal tubular formations. Necrotic foci and numerous mitotic figures were present. Immunohistochemically, tumor cells were positive for pancytokeratin, high molecular weight cytokeratin (CK), CK5/6, CK7, CK14, CK18, CK19, epithelial membrane antigen, vimentin, p53 protein, surfactant apoprotein A, neuron-specific enolase, lysozyme, Ki-67 (60%), and CD68. Tumor cells were negative for CK20, thyroid transcriptional factor-1, CEA, S100 protein, desmin, α-smooth muscle actin, melanosome, CD34, p63, chromogranin, synaptophysin, CD56, KIT, and platelet-derived growth factor-α. It appeared that the present pulmonary PC is associated with adenocarcinoma or derived from sarcomatous transformation of adenocarcinoma.

Pleomorphic Carcinoma of the Lung with Mediastinal Extension Following Malignant Lymphoma: Report of a Case

In following up a patient with non-Hodgkin's lymphoma, we encountered a case of pulmonary pleomorphic carcinoma with mediastinal direct invasion. A 65-year-old man with hemoptysis was found to have an abnormal shadow in the right upper lung field. A 6.4 x 4.8-cm tumor adjacent to the upper mediastinum occupied the right anterior segment of the upper lobe (S3) and invaded the superior vena cava (SVC). The serum level of neuron-specific enolase was elevated to 11.9 ng/ml. A specimen from a transbronchial lung biopsy of the right B3b bronchus revealed giant tumor cells. A right upper lobectomy with SVC reconstruction was performed. The resected tumor was diagnosed as a pulmonary pleomorphic carcinoma with a large component of giant and spindle cells, and it is considered to be a rare histologic type.

肺過誤腫を合併した肺原発多形癌の１例

肺過誤腫を合併した肺原発多形癌の１例