Giant Cell Cancer of the Lung

Abstract

Bronchogenic carcinoma is the most common primary tumor affecting lung. Four main histopathological subtypes of bronchogenic carcinoma are recognized, and several variants of these histopathological subtypes are also known. Among the 4 main histopathological subtypes of bronchogenic carcinoma, large cell carcinoma is the least commonly encountered. Rarer still is a subtype of large cell carcinoma known as giant cell carcinoma. We report the detection and characterization of pulmonary giant cell carcinoma using 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET-CT). FDG-PET-CT showed intense hypermetabolic activity within the primary lesion, which subsequently decreased, and then resolved following antineoplastic therapy. FDG-PET-CT also allowed detection of sites of recurrence of the tumor following cessation of therapy. This report highlights the usefulness of FDG-PET-CT for the detection of an unusual thoracic neoplasm as well as the ability of FDG-PET-CT for assessing response to therapy.Key Words: pulmonary neoplasia, large cell carcinoma, giant cell carcinoma of lung, non-small-cell carcinoma, positron emission tomography, computed tomography, hypermetabolic, response to therapy (Clin Pulm Med 2010;17: 106 -108) B ronchogenic carcinoma is the most common primary tumor of the lung. The most common histopathological subtypes of bronchogenic carcinoma are adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and large cell carcinoma. Additional varieties of these histopathological subtypes are recognized as well.Among the 4 main histopathological bronchogenic subtypes, large cell carcinoma is the least commonly encountered. Pulmonary giant cell carcinoma is a rare, aggressive form of large cell carcinoma with a very poor prognosis. We report a patient in whom giant cell carcinoma of the lung was detected by 18 F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (PET/ CT) scanning. This report illustrates the usefulness of PET/CT in the diagnosis and staging of a pulmonary giant cell carcinoma as well as for monitoring treatment response following combination radiation and chemotherapy. CASE REPORTA 63-year-old white woman with abdominal pain and fatigue was admitted to the hospital. Prior to admission, the patient had sudden sharp abdominal pain, which was presumed to be a urinary tract infection. She was given antibiotics without effect. On admission, a CT of her abdomen revealed diffuse thickening of the greater omentum with a 4 ϫ 2.4 cm ovoid soft tissue mass in the right pelvis. Biopsy of this mass showed multiple necrotizing granulomas that were suggestive of an infectious process, although further studies revealed no infectious etiology. A PET/CT was performed (Figs. 1A, B), which demonstrated a large focus of intense metabolic activity within the subaortic space of the mediastinum; the maximum standardized uptake value was 13.5. There was additional hypermetabolism within the right paratracheal lymph node and in the suprasternal and left p...