A case of primary lung pleomorphic carcinoma incidentally noted in a pneumothorax surgical specimen

Abstract

A 70-year-old man presented to our hospital with sudden dyspnea. Chest computed tomography (CT) revealed right pneumothorax along with combined pulmonary fibrosis and emphysema in the background lung, without evidence of a tumor. Thoracoscopic partial resection of the right lower lobe was performed following persistent air leakage even after thoracic drainage. A 5-mm fistula, detected intraoperatively in the lower lobe of the right lung, was resected using a stapling device. Postoperative pathology revealed squamous cell carcinoma and sarcomatous components including spindle and giant cells at the fistula site, with positive resection margins. Following a diagnosis of pleomorphic carcinoma, thoracoscopy-assisted right lower lobectomy with lymph node dissection was performed as a secondary radical operation. Pathological diagnosis was pleomorphic carcinoma, partially involving the visceral pleura, pT2a (pl2) N0M0 stage IB. The patient recovered well postoperatively and did not require home oxygen therapy. He had no evidence of recurrence and is currently under outpatient observation, one year postsurgery. A diagnosis of lung cancer from surgical specimens of pneumothorax is rare, and there are no reports of pleomorphic carcinoma. We report this case with a literature review.