Jeong Jae-Han, Seo Hong-Joo, Yoon Sung-Ho, Hong Ran
Department of Thoracic and Cardiovascular Surgery, Republic of Korea.
Department of Internal Medicine, Republic of Korea.
Respir Med Case Rep. 2020 Sep 14;31:101225. doi: 10.1016/j.rmcr.2020.101225. eCollection 2020.
Pulmonary pleomorphic carcinoma (PPC) is a poorly differentiated non-small cell lung carcinoma, including squamous cell carcinoma, adenocarcinoma, or undifferentiated non-small cell lung carcinoma with at least 10% spindle and/or giant cells. Here, we report a case of PPC showing undifferentiated non-small cell lung carcinoma with giant cells. A 71-year-old man with dyspnea underwent right lobectomy because of a mass in the right upper lobe of the lung. A 5.0 × 3.0 × 1.5 cm-sized tumor was identified; microscopically, the tumor composed of undifferentiated large sized tumor cells admixed with syncytial tumor giant cells and emperipoletic giant cells. Immunohistochemically, the tumor cells were reactive for pan-cytokeratin, but negative for P40, thyroid transcription factor 1 (TTF-1), and vimentin. The tumor cells were also positive for 3 clones of programmed death-ligand 1 (PD-L1). The clinical and histologic findings supported the diagnosis of an undifferentiated non-small cell lung carcinoma with giant cells, which is a subtype of pulmonary pleomorphic carcinoma. Unfortunately, after surgery, multifocal lymph node metastasis was identified in radiologic examination. Only palliative chemotherapy was administered to the patient, although he was indicated for immunochemotherapy. Pulmonary pleomorphic carcinoma is known to have a poor prognosis, even in early stages of the disease, therefore, we should be careful in the diagnosis to ensure optimal treatment.
肺多形性癌（PPC）是一种低分化非小细胞肺癌，包括鳞状细胞癌、腺癌或具有至少10%梭形和/或巨细胞的未分化非小细胞肺癌。在此，我们报告一例显示为具有巨细胞的未分化非小细胞肺癌的PPC病例。一名71岁男性因呼吸困难接受了右肺上叶肿块的右肺叶切除术。发现一个大小为5.0×3.0×1.5 cm的肿瘤；显微镜下，肿瘤由未分化的大尺寸肿瘤细胞与合体性肿瘤巨细胞和吞噬细胞性巨细胞混合组成。免疫组织化学检查显示，肿瘤细胞对泛细胞角蛋白呈阳性反应，但对P40、甲状腺转录因子1（TTF-1）和波形蛋白呈阴性反应。肿瘤细胞对程序性死亡配体1（PD-L1）的3个克隆也呈阳性。临床和组织学检查结果支持诊断为具有巨细胞的未分化非小细胞肺癌，这是肺多形性癌的一种亚型。不幸的是，术后影像学检查发现多灶性淋巴结转移。尽管该患者适合免疫化疗，但仅给予了姑息性化疗。已知肺多形性癌预后较差，即使在疾病早期也是如此，因此，我们在诊断时应谨慎，以确保最佳治疗。
