A Rare Case of Combined Small‐Cell Lung Cancer with Unusual Soft Tissue Metastasis

Abstract

Combined small-cell lung carcinoma (SCLC) is a rare tumor. We report a case of combined SCLC of the lung, including adenocarcinoma and spindle-shaped cell tumor, with an unusual initial presentation. The patient suffered from a right shoulder mass, subsequently undergoing biopsy. A lung nodule was noted later after complete examination. The diagnosis turned out to be combined cell carcinoma with three different components (small-cell carcinoma, adenocarcinoma, and spindle-shaped cell tumor) after examination upon total removal of the lung nodule by lobectomy. In addition to the rarity of the three components in such a tumor, soft tissue metastasis also made it an unusual case.

Etoposide-Cisplatin Alternating with Vinorelbine-Cisplatin Versus Etoposide-Cisplatin Alone in Patients with Extensive Disease Combined with Small Cell Lung Cancer

“…These NSCLC components may be large-cell neuroendocrine C-SCLC accounts for 2-28% of all SCLC cases (Adelstein et al, 1986;Mangum et al, 1989;Nicholson et al, 2002). Currently, the literal documentations for C-SCLC are rare with sporadic case reports (Hsiao et al, 2006). Therefore, the optimal therapy for C-SCLC are still not been defined.…”

Unusual presentation of an uncommon lung malignancy

“…Combined SCLC in the majority of cases reported has been a postoperative diagnosis using microscopic examination of the surgical resected specimens8–10. Rare cases of combined SCLC have however been diagnosed using a transbronchial lung biopsy (TBLB) or mediastinoscopic biopsy910. In the present case, the diagnosis of combined SCLC was established by histopathologic examination, including immunohistochemistry of the bronchoscopic biopsy specimen.…”

“…The central location of the tumour in the present case was unusual. Combined SCLC in the majority of cases reported has been a postoperative diagnosis using microscopic examination of the surgical resected specimens8–10. Rare cases of combined SCLC have however been diagnosed using a transbronchial lung biopsy (TBLB) or mediastinoscopic biopsy910.…”

Combined small-cell carcinoma of the lung with quadripartite differentiation of epithelial, neuroendocrine, skeletal muscle, and myofibroblastic type

“…Worth mention was the widespread reactivity for CD56 (a sensitive but not specific marker of neuroendocrine differentiation) in the spindle cell sarcoma component, a feature which could be somewhat related to the reported distribution of the molecule in mesoderm during fetal life, rhabdomyosarcoma [12], leiomyosarcoma [13], sarcomatoid mesothelioma [14], or other biphasic tumors [15]. Combinations of small cell carcinoma with spindle cell [9,11] or giant cell carcinoma [4,8], small cell carcinoma plus adenocarcinoma and spindle-shaped cell tumor [7], small cell carcinoma plus squamous cell carcinoma and spindle cell carcinoma [6], or small cell carcinoma plus sarcomatoid carcinoma with either spindle cell or giant cell carcinoma [5] are exceedingly rare but well-known occurrences among combined variants of SCLC, as well as associations of atypical carcinoid plus rhabdomyosarcoma [10], carcinoid plus hamartoma [16,17], carcinoid plus adenocarcinoma [18,19], or incidental small neuroendocrine lesions resembling tumorlets in intrathoracic lymph nodes of patients with primary lung adenocarcinoma [20]. Intimate intermingling of small cell carcinoma and rhabdomyoblasts in the larynx [21], skin, nasal cavity, urinary bladder [22], and anorectal junction [23], as well as tripartite differentation in individual cells carcinomas with concurrent epidermoid, glandular, and neuroendocrine features in lung [24] or esophagus [25] or dipartite differentiation with rhabdomyogenous and cytokeratin expression within the same mesenchymal tumor cells in pulmonary carcinosarcomas [26] are likely to be further variants on the theme of multidirectional differentiation of common tumor ancestors.…”

“…In this frame of mind, the combination with sarcoma or sarcoma-like elements is deemed to be exceedingly rare, probably reflecting the inherent rareness of pulmonary sarcomatoid carcinomas, which account for by far less than 5% of all NSCLC [3]. While diverse variations on the theme of combined small cell carcinoma with sarcoma or sarcomalike elements have been described in the English literature [4][5][6][7][8][9][10][11], quadripartite differentiation clustering epithelial, neuroendocrine, skeletal muscle, and smooth muscle/myofibroblastic features has not thus far been reported in the lung, to the best of our knowledge.…”