The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
A case of rapid progress of pulmonary pleomorphic carcinoma with ground glass nodules following solid metastasis in the right lung
Keiji InoueMasataka HirabaruMasachika Kitajima
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2019 Volume 33 Issue 5 Pages 498-503

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Abstract

We report a case of pulmonary pleomorphic carcinoma that showed rapid progression with 4-year remission after the first operation. On CT examination, the tumor showed a ground glass appearance in the first operation, but the recurrent tumor was solid.

A 74-year-old man was referred to our department for a 3-cm GGN in the upper lobe of the right lung on a medical examination. We performed an upper lobectomy of the right lung with lymph node dissection. Histopathology of the resected specimen revealed mixed adenocarcinoma, with a pathological stage of IA (pT1bN0M0). A regimen of carboplatin (CBDCA) +irinotecan (CPT-11) was administered, because the multiple new GGNs occurred 2 years after the first operation. The GGNs after the chemotherapy were classed as stable disease.

A new solid nodule appeared in the right lower lobe 4 years after the first operation. The solid tumor was evaluated as newly developed primary lung cancer and was resected. Histopathology of the tumor showed pleomorphic carcinoma with spindle cells, papillary adenocarcinoma, and bronchioloalveolar cell carcinoma. The patient died of the cancer 3 months after the second operation, with rapidly growing multiple metastases. Re-examination of the specimen showed pleomorphic carcinoma with 10% of the area showing spindle cell carcinoma. The ratio of spindle cells may be associated with this prognosis.

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© 2019 The Japanese Association for Chest Surgery
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