Primary Squamous Cell Lung Cancer Research Articles

Primary Squamous Cell Lung Cancer With Frequent Episodes of Sustained Ventricular Tachycardia due to Myocardial Metastasis

Myocardial metastasis from lung cancer rarely occurs. We encountered a patient with squamous cell lung cancer who was diagnosed with myocardial metastasis before death and sustained ventricular tachycardia during the course of the disease. The patient was a 56-year-old woman. A tumor was noted in the apex area of the left lung and was diagnosed as stage IVA of squamous cell lung cancer after a detailed examination. She underwent concurrent chemoradiotherapy with weekly treatment of carboplatin + paclitaxel. A 12-lead electrocardiogram performed upon admission for additional chemotherapy showed negative T waves in leads III, aVF, and V1-4. Transthoracic echocardiography and computed tomography showed a tumor lesion in the right ventricular wall, which was diagnosed as myocardial metastasis from lung cancer. During the course of the disease, the patient had frequent episodes of sustained ventricular tachycardia, which were refractory to treatment with antiarrhythmic drugs. However, the sinus rhythm was restored with cardioversion. Subsequently, the patient received palliative treatment and eventually died 4 months after the diagnosis of cardiac metastasis and 3 weeks after the diagnosis of ventricular tachycardia. Myocardial metastasis might reflect poor prognosis due to serious arrhythmia or some other complications. Therefore, the early diagnosis and appropriate treatment of cardiac metastasis by chemotherapy, cardiac radiotherapy, or surgery, are necessary prior to the development of symptoms in tolerant cases. J Med Cases. 2023;14(4):111-117 doi: https://doi.org/10.14740/jmc4066

Clinical effects of cisplatin plus recombinant human endostatin (rh-endostatin) intratumoral injection on malignant central airway obstruction: a retrospective analysis of 319 cases.

BackgroundPrimary lung cancer with severe central airway obstruction (CAO) is often life-threatening. In this study, we investigated the clinical efficacy and safety of cisplatin plus recombinant human endostatin (rh-endostatin) intratumoral injection in treatment of malignant central airway obstruction (MCAO) caused by primary squamous cell lung cancer.MethodsWe retrospectively analyzed patients with MCAO caused by primary squamous cell lung cancer treated with and without bronchoscopic intratumoral injection of cisplatin plus rh-endostatin between January 2007 and June 2016.ResultsA total of 206 patients received cisplatin plus rh-endostatin intratumoral injection, and 113 without injection. Dyspnea grade, degree of stenosis, quality of life and lung function of all patients were significantly improved at 1 week after treatment compared with baseline. Both groups achieved good airway patency (97.1% vs. 93.8%, P=0.156). Followed up at 2 months, all parameters were improved in the injection group compared with baseline, while no statistical differences were observed in the non-injection group (P>0.05). The injection group achieved airway patency in 155 (75.2%) of 206 patients, which was significantly superior to the non-injection group [20 (17.7%) of 113, P<0.001]. In addition, the restenosis rate of the injection group was lower compared with the non-injection group (22.5% vs. 81.1%, P<0.001, respectively). No serious complications were observed in two groups.ConclusionsCisplatin plus rh-endostatin intratumoral injection is effective and safe for the therapy of MCAO caused by primary squamous cell lung cancer.

Clinicopathological comparison and therapeutic approach to Castleman disease-a case-based review.

Castleman disease (CD) is a rare, B-cell lymphoproliferative disorder affecting lymph nodes and extranodal anatomical locations. Four types of clinical presentations can be distinguished after exclusion of mimics. The first division is into unicentric CD (UCD) and multicentric CD (MCD). MCD is classified further as HHV-8-negative (idiopathic), MCD associated with HHV-8 infection, and POEMS associated MCD. From the histological standpoint, UCD and MCD can be classified as hyaline-vascular (HV), plasma cell (PC), or mixed cellularity (MC) type, with a spectrum of histopathological manifestations. We present clinical and histopathological features and grading of 25 cases of CD classified according to CDCN histological criteria and according to this clinical algorithm, along with outcomes. Here we provide a fine-resolution description of the histological features of CD. We review and discuss the current diagnostic algorithm, grading system, and recently recommended treatment options. In the presented group of 25 patients with CD there were 14 women and 11 men in the age range 15-79 years. UCD was identified in 15 patients and it was most often located in mediastinum. MCD most frequently occurred as generalized lymphadenopathy. The most common type of CD was HV. All patients with UCD underwent complete surgical resection with a positive outcome. Patients with MCD had diagnostic partial surgical excision of the lesions, later followed by different types of treatment (corticosteroids, chemotherapy, radiotherapy, immunomodulatory agents) or 'watch and wait'. In four cases CD was associated with other malignancies (laryngeal cancer, small lymphocytic lymphoma, gallbladder cancer with hepatic metastases, primary squamous cell lung cancer). The accuracy of histopathological examination is essential and re-evaluation has to be performed in case of relapse or unexpected course of CD. Treatment tailored to fit the disease type and severity should follow the novel recommendations, including anti-IL-6 treatment in the case of MCD.

Pseudomesotheliomatous Primary Squamous Cell Lung Carcinoma: The First Case Reported in Turkey and a Review of the Literature.

In rare cases, pseudomesotheliomatous tumors spread diffusely within the pleura to form an encasing mass, which may be confused with diffuse malignant mesothelioma (DMM). A 73-year-old male presented with chest pain, dyspnea and a significant loss of weight and appetite. His radiological and clinical features suggested DMM. However, immunohistochemical studies revealed a primary squamous cell cancer of the lung. To the best of our knowledge, this is the first case report of pseudomesotheliomatous primary squamous cell lung cancer in Turkey, and also the seventh case worldwide. The present report aims to present this case, along with a review of the medical literature.

Spontaneous regression of a primary squamous cell lung cancer following biopsy: a case report

BackgroundSpontaneous regression has been defined as occurring when the malignant tumor mass partially or completely disappears without any treatment or as a result of a therapy considered inadequate to influence systemic neoplastic disease. Recently, studies have implicated immunological responses as likely being involved. We report a case of a patient with squamous cell carcinoma of the lung who experienced spontaneous regression following biopsy without other intervention.Case presentationA 57-year-old white man was referred to our pulmonary clinic after an incidental finding of a nodule in the lower lobe of his left lung. Thoracic computed tomography revealed a 2.0 × 1.4 × 1.5 cm spiculated nodule in the superior segment of the left lower lobe. Workup identified the mass as a squamous cell carcinoma that was clinically staged as T1M0N0. The patient deferred treatment of this lesion. He undertook no significant lifestyle or medical changes. Three months later, computed tomography revealed that, compared with the initial study, the solitary mass had decreased in size to 1.6 × 0.9 × 0.9 cm. Follow-up computed tomography 1 year after the original workup demonstrated that the nodule had stabilized to its smaller size.ConclusionsStudies have shown that immunological response can be initiated by trauma to an area. Because the tumor regression became evident in our patient only after the tissue biopsy, his immune response to the surgical procedure seems to be a plausible contributor to the spontaneous regression. Further understanding of spontaneous regression can potentially impact the identification of neoplastic drug targets or even the course of a patient’s treatment plan and goals.

High Secretion of Beta-HCG by Squamous Cell Carcinoma of the Lung in a Postmenopausal Female

With the development of research in tumor, some of them have been found to secrete beta-human chorionic gonadotropin (β-HCG) ectopically and lung cancer is one of them. Generally, lung cancer secreting β-HCG is mostly undifferentiated small cell carcinoma. Here, we report a rare case of squamous cell lung cancer secreting high level of β-HCG in a postmenopausal female. The tumor secreted β-HCG, measuring 16,500 mIU/ml. The patient presented with hemoptysis and postmenopausal bleeding. Pathological examination of CT-guided biopsy and investigations could not tell whether it was primary squamous cell lung cancer or choriocarcinoma with lung metastasis, to be responsible for the high level of β-HCG. The chemotherapy in the early stage seemed to be effective, but not good in the late stage. Then she underwent a right pulmonary middle lobectomy and the pathological examination finally confirmed the diagnosis of poorly differentiated squamous cell carcinoma. The auxiliary chemotherapy made a decreased β-HCG. Only a few reports of squamous cell lung cancer secreting that high level of β-HCG can be found in the literature.

A Rare Synchronous Tumor Combination of Primary Squamous Cell Lung Cancer and Urinary Papillary Cell Carcinoma

A Rare Synchronous Tumor Combination of Primary Squamous Cell Lung Cancer and Urinary Papillary Cell Carcinoma

Case of metastatic pulmonary carcinoma in optic disc diagnosed from results of biopsy performed during vitrectomy surgery

Most intraocular metastatic tumors occur in the uveal tract, while isolated metastasis to the optic nerve is rarely found. We report a case of metastasis to the optic disc from primary lung cancer, diagnosed from biopsy findings obtained during a vitrectomy. A 69-year-old male presented with gradual visual impairment due to a milky white tumour that extended from the optic disc into the vitreous cavity. A systemic examination revealed primary squamous cell lung cancer. A biopsy specimen was obtained from the optic disc tumor during a vitrectomy, which led to a diagnosis of metastasis from lung cancer. Despite courses of chemotherapy and radiotherapy, the patient died of brain metastasis. There are few reports of secondary optic disc tumors and pathological biopsy findings are rare. When a milky white tumor is observed extending from the optic disc, a possible differential diagnosis is metastatic neoplasm.

Abstract A20: FGFR1-amplified squamous cell lung cancers depend on FGFR1

Abstract In lung adenocarcinomas of never-smokers EGFR mutations or EML4-ALK gene fusions are frequent genomic events that both expose prime therapeutic targets. By contrast, squamous cell lung cancer (SQLC) is almost invariably associated with smoking; in this subgroup of patients, no attractive therapeutic target has so far been identified. In order to identify such a therapeutically exploitable target in SQLC, we performed high-resolution genomic analyses of over 300 lung tumor specimens. Using 6.0 Affymetrix SNP-arrays we identified high-level focal amplifications of FGFR1 in 10% of over 150 primary SQLC specimens. Importantly, FGFR1 amplification was almost exclusively restricted to SQLC of smokers and almost never observed in adenocarcinomas. We also performed high-throughput cell line screening of 82 genomically annotated lung cancer cell lines using the FGFR inhibitor PD170374 and identified the presence of focal FGFR1 -amplifications as the strongest predictor of PD170374 activity. Biochemical kinase profiling across 108 kinases suggested that PD170374 was highly selective with only one of the kinases being inhibited to a similar extend as FGFR1 itself. Treatment with PD173074 induced apoptosis and inhibited MAPK- and, to a lesser extend, PI3K signaling in cell lines with focal amplification of FGFR1. In order to validate FGFR1 as a critical target in FGFR1 -amplified cells we employed retroviral expression of the gatekeeper mutant allele of FGFR1 (V561M) and thus the PD173074-sensitive cells were rendered resistant. Additionally, lentiviral-mediated knockdown of FGFR1 in FGFR1 -amplified cell lines confirmed FGFR1 as a critical target for FGFR1 inhibition in these cells. Finally, successful treatment of mice engrafted with FGFR1 -amplified lung cancer cell lines with PD173074 confirmed its on-target activity in vivo. Overall, our work demonstrates the functional relevance of amplification of FGFR1 in lung cancer and suggests that inhibition of FGFR with targeted therapeutics might be an effective strategy in squamous cell carcinoma patients with focal amplification of FGFR1. Citation Information: Clin Cancer Res 2010;16(14 Suppl):A20.

A strong inverse correlation between p16INK4a and pRb expression is observed at the level of individual tumor cells in HPV‐negative primary squamous cell lung cancer

BackgroundA wide range of human papillomavirus detection (&lt;10–&gt;80%) has been reported in pulmonary squamous cell carcinoma (SCC). Our aim is to investigate the potential co‐etiologic role of HPV in a series of North American lung cancers and to evaluate whether p16INK4aoverexpression, a marker of HPV integration in cervical SCC, is seen in pulmonary SCC.MethodsDNA extracted from formalin‐fixed paraffin‐embedded tissue from 48 consecutive cases of surgically resected pulmonary SCC at Stony Brook University Medical Center (2003–2008) was analyzed for 16 types of HPV by multiplex PCR. Immunohistochemistry was performed to evaluate expression of p16INK4a and pRb.ResultsOne case (2%) was positive for HPV DNA by multiplex PCR. Nuclear and cytoplasmic p16INK4a expression in tumor cells was detected by IHC in 22% and focal expression was present in normal bronchial glands in 49%. Nuclear expression of pRb was detected in 84% in a peripheral predominant pattern. An inverse correlation of p16INK4a and pRb expression was observed at the level of individual cells.ConclusionHPV is not detected in most pulmonary SCCs from our NE US patient population. p16INK4a overexpression is present in up to 25% of HPV‐negative pulmonary SCC and is inversely correlated with pRb expression at the level of individual tumor cells. Therefore, p16INK4a should not be used to distinguish between primary and HPV‐related metastatic disease.

Silicone Y stent placement at secondary left carina for malignant central airway obstruction

The Y silicone stents are shaped with long tracheal and left main bronchial limbs and a shorter right main bronchial limb. These stents can be used for patients with fixed or dynamic central airway obstruction from benign or malignant disease. 1 More often, these stents are used for patients with extensive tumor involvement in the lower trachea and mainstem bronchi. 2 To our knowledge, their use specifically for unilateral central airway obstruction has not been previously published. In this report, we describe the indication, method, and outcome of Y stent insertion at the level of the secondary left carina separating the left upper and lower lobe bronchi, to restore airway patency ofthe left lobar bronchi in a patient with primary squamous cell lung cancer. CLINICAL SUMMARY A7 3-year-old man with hemoptysis was found to have a left infrahilar mass involving the distal left main bronchus and the entrance of the lobar bronchi (Figure 1). Rigid bronchoscopy, neodymium:yttrium-aluminum-garnet laser photocoagulation and debulking was performed under general anesthesia with assisted spontaneous ventilation using a 13-mm Efer-Dumon rigid ventilating bronchoscope (Bryan Corporation, Woburn, Mass). Tumor infiltration, cartilaginous collapse, and extrinsic compression prompted insertion of a Y silicone stent (16-mmdiameter tracheal, 12-mm-diameter bronchial limbs) within the left main bronchus. The left bronchial limb was shortened to 1.5 cm using a scalpel prior to loading the longitudinally folded stent into a large, rigid, stent introducer tube. The stent was then deployed into the entrance of the left upper lobe bronchus. While the stent was still partially folded along its long axis, rigid forceps were used to grasp the stent and pull it proximally into the distal left main bronchus, allowing unfolding of the right bronchial limb into the relatively straight left lower lobe bronchus. Forceps were then used to push the stent down onto the secondary left carinal spur. The right limb of the Y stent was thus directed into the left lower lobe bronchus while the left limb was shortened to provide access into the left upper lobe bronchus (Figure 2). There were no perioperative complications. The patient received chemotherapy and radiation therapy. Bronchoscopy 4 months later revealed patent airways and no evidence of stent-related complications. At 1-year follow-up, the patient’s airways remain patent.

Survival after surgical resection of pulmonary metastases and second primary squamous cell lung carcinomas in head and neck cancer

Patients with head and neck squamous cell carcinoma (HNSCC) are at risk for developing both pulmonary metastasis and second primary lung cancer (SPLC). The objective of this study was to determine survival characteristics of patients with pulmonary lesions after curative treatment for HNSCC. Lung resection or biopsy specimens of 36 patients, curatively treated for HNSCC between 1978 and 2002, were defined as second primary squamous cell lung cancer or metastasis by loss of heterozygosity (LOH analysis). Twenty-two of them underwent surgical resection. Survival characteristics were estimated using Kaplan-Meier analysis according to the LOH characterization. The number of resected lung lesions ranged from 1 to 3. Median overall survival after lung surgery was 23.1 months for SPLC (n = 14) and 25.1 months for lung metastases (n = 8). Fourteen patients, SPLC (n = 6) and metastases (n = 8), did not undergo surgical resection, and their median overall survival was 3.7 and 4.4 months, respectively. Survival after resection of metachronic lung lesions following curative treatment of HNSSC is similar for lesions characterized as second primary squamous cell lung cancer and those characterized as metastases.

A recurrent chromosome 4 marker in primary squamous cell lung cancer

A sample of eight primary lung tumors histologically identified as squamous cell type carcinomas (SQC) were cytogenetically analyzed after a short-term (7 days) culture. Several numerical and structural abnormalities were observed. As G-banding analysis is unable to fully characterize complex marker chromosomes, we applied the fluorescence chromosome painting technique to identify one as a marker derived from a chromosome 4 that has not been described until now. We found it in half of the analyzed cases.

Preoperative CYFRA 21-1 level as a prognostic indicator in resected primary squamous cell lung cancer.

The CYFRA 21-1 assay is a test that has been developed recently for detection of a cytokeratin 19 fragment in serum. A diagnostic role for CYFRA 21-1 has already been proposed. The question of whether this marker is prognostically significant is important in clarifying the role of CYFRA 21-1 in clinical practice. The aim of this study was to evaluate the prognostic significance of elevated preoperative CYFRA 21-1 levels in patients with resected primary squamous-cell lung cancer (SqCC). Serum levels of CYFRA 21-1 were measured using an immunoradiometric assay (CIS bio) in 91 patients with operable SqCC. Survival and disease-free survival curves related to initial levels of this marker were estimated using the Kaplan-Meier method. In the univariate analysis the log-rank test and the log-rank test for trend were used. In the multivariate analysis the stratified log-rank test and the proportional hazard model were used. Elevated preoperative CYFRA 21-1 levels were identified in 55% of patients with SqCC. The number of patients with elevated levels of this marker increased with TNM stage (P = 0.0001). In univariate analysis elevated levels of CYFRA 21-1 were significantly associated with poor overall survival (P < 0.00005) and with disease-free survival (P < 0.00005). In multivariate analysis elevated levels of this marker were also found to be associated with poor overall and disease-free survival (P = 0.01 and P = 0.003 respectively). In conclusion, CYFRA 21-1 may be an independent prognostic parameter of survival and tumour relapse in SqCC and may be useful in identifying resected SqCC patients at high risk of treatment failure.