An Autopsy Case of Rapidly Progressing Spindle Cell Carcinoma of the Lung Accompanied with Intratumor Hemorrhage

Abstract

Patient: Male, 74Final Diagnosis: Spindle cell carcinoma of the lungSymptoms: —Medication: Pemetrexed • carboplatinClinical Procedure: Biopsy and autopsySpecialty: OncologyObjective:Rare diseaseBackground:Spindle cell carcinoma (SPCC) of the lung is a subset of sarcomatoid carcinoma. Its clinical features are unclear because of its rarity. Here, we report an autopsy case of SPCC and review CT findings and chemotherapeutic regimens based on previous reports of this disease. To our knowledge, this is the first reported case of pemetrexed used to treat SPCC.Case Report:A 74-year-old Japanese male presented with dyspnea and contrast-enhanced computed tomography (CT) showed abundant left pleural effusion and a mass in lower lobe of the left lung. By the tumor biopsy, he was diagnosed for SPCC of the lung, cT3N0M1a, stage IV. The tumor was resistant to chemotherapy with carboplatin and pemetrexed, and rapidly progressed. Autopsy revealed abundant hemorrhage within the tumor, which apparently reflects a low-density area in CT.Conclusions:Present case and the accumulation of cases indicate that low-density areas in CT and rapid tumor progression may be common SPCC findings.

Pulmonary spindle cell carcinoma with unusual morphology

“…All forms of SC have a low incidence, and PSCC is very rare, accounting for only 0.2% to 0.3% of all lung cancers. [ 6 ] We reviewed the PSCC case reports published in English, [ 4 , 6 – 11 ] and our present case, and summarized the clinical features of PSCC (Table 1 ). A total of 11 cases were analyzed, including 6 men and 5 women.…”

“…In all 5 PSCC cases with CT scan images, central, low-density regions were found in the lesions, which might be the most specific imaging feature of PSCC. Kida et al [ 4 ] suggested that this feature was related to hemorrhage at the center of the lesion. Five patients had involvement in the pleura or other distal organs.…”

“…Most of the time, radiotherapy and chemotherapy could alleviate the diseases, but these treatments may not be particularly suitable for patients in poor physical conditions. [ 4 ] Only 3 of the 11 patients had a survival of more than 24 months, which indicates that PSCC is a highly malignant tumor, and the prognosis of PSCC is poor, even in early stage. Recent comprehensive genomic profiling studies showed that genomic alterations of tumor protein p53 (74%), V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (34%), hepatocyte growth factor receptor gene (MET) (13.6%), epidermal growth factor receptor (8.8%), V-raf murine sarcoma viral oncogene homolog B (7.2%), human epidermal growth factor receptor 2 (1.6%), or ret proto-oncogene (0.8%) were identified in PSCs, and tyrosine-protein kinase Met (C-MET) exon 14 alterations were more frequently in PSC (12%) than in non-PSC non-small cell lung cancers (3%).…”

“…[ 1 ] SCC occurs in the oral cavity, larynx, breast, kidney, uterus, conjunctiva, prostate, other organs, and occasionally in the lungs. [ 1 – 4 ] PSCC can be manifested by a variety of histological and morphological characteristics and is easily misdiagnosed. Currently, there are few reports of PSCC, and the clinical characteristics, diagnosis, and treatment strategy of PSCC are not well-known.…”

Clinicopathological characteristics and prognosis of pulmonary spindle cell carcinoma (PSCC): a population-based retrospective study

“…Unique clinical and pathological characteristics and prognosis have seldom been illustrated yet. Even diagnosed at the early stage, PSCC showed an unsatisfied prognostic outcome (1)(2)(3). Lung biopsy is crucial for the patients suffered from PSCC, due to the incompletion of preoperative diagnosis under most circumstances.…”