Pleomorphic Carcinoma of the Lung

Abstract

Pleomorphic carcinoma (PC) of the lung is rare, and it is classified as a subtype of sarcomatoid carcinoma of the lung in the World Health Organization histologic classification of lung tumors. In this study, 70 cases of PC surgically resected were reviewed to identify its clinicopathologic characteristics. There were 57 men and 13 women, and their mean age was 66 years (range: 29 to 80 y). Sixty-eight tumors contained identifiable epithelial components, and the other 2 consisted of spindle cells and giant cells alone. An adenocarcinoma component was found in 34 cases, a squamous cell carcinoma component in 13, and a large cell carcinoma component in 40. The overall survival rate and disease-free survival rate were 36.6% and 40.7%, respectively, and both rates were significantly lower than for other nonsmall cell lung carcinomas. When the PC patients were divided into 3 groups according to the predominant epithelial component, an adenocarcinoma group, squamous cell carcinoma group, and large cell carcinoma group, there were no significant differences in the overall survival rate and median survival time between the 3 groups. Univariate analysis revealed that advanced stage (stage III), mediastinal lymph node metastasis, lymphatic permeation, and histologically diagnosed massive coagulation necrosis (>25% of the tumor) predicted poorer disease-free survival. Multivariate analysis showed that massive necrosis alone was an independent prognostic factor. We concluded that PC should be considered as an aggressive disease and massive necrosis should be routinely reported and used as a factor in clinical assessments.

Air bronchogram in pleomorphic carcinoma of the lung is associated with favorable prognosis

“…According to several published reports of relatively large patient samples, the five‐year OS rate of patients with PC of the lung after surgery is < 40% 6, 11, 12. Yuki et al .…”

“…, 13 Mochizuki et al . reviewed 70 cases of surgically resected PC of the lung and reported that histologically proven massive coagulation necrosis was a poor prognostic factor 6. Fujisaki et al .…”

“…In our study, an air bronchogram tumor was significantly associated with the absence of tumor necrosis and the presence of an adenocarcinoma component with lepidic pattern. Previous reports have shown that massive coagulation necrosis is a poor prognostic indicator for patients with PC of the lung 6. Lepidic adenocarcinoma is known to be a low‐grade malignancy among adenocarcinoma subtypes.…”

“…Previous studies examined the prognostic impacts of the clinicopathologic characteristics of PC of the lung, and showed that massive coagulative necrosis or a massive central low‐attenuation area of the tumor were negative prognostic factors 6, 7. Coagulative necrosis observed in PC of the lung would suggest rapid proliferation of the tumor; in addition, it may facilitate systemic tumor dissemination through impairment of tumor vasculature 6, 7. To date, information regarding the impact of CT features on survival of patients with PC of the lung is quite limited.…”

Pulmonary pleomorphic carcinoma: A case harboring EGFR mutation treated with EGFR‐TKIs

“…PPC is defined as a poorly differentiated non‐small cell lung cancer (NSCLC) containing spindle cells and/or giant cells, or a carcinoma that comprises spindle or giant cells alone, in at least 10% of the tumor 4. It has an aggressive clinical course and can show resistance to chemotherapy, which is an actively applied treatment for NSCLC 5, 6.…”