Hamabe Kenta, Kuroshima Yoshiaki, Takaya Hisashi, Morinaga Shojiroh, Okuzumi Shinichi, Kakimoto Tomoo, Minematsu Naoto
Department of Medicine, Hino Municipal Hospital, Tokyo 191-0062, Japan.
Department of Neurosurgery, Hino Municipal Hospital, Tokyo 191-0062, Japan.
Oncol Lett. 2023 Mar 8;25(4):162. doi: 10.3892/ol.2023.13748. eCollection 2023 Apr.
Cystic brain metastasis is a rare condition that mainly originates from lung or breast adenocarcinomas. By contrast, pulmonary spindle cell carcinoma, a rare type of non-small cell carcinoma, has not been reported with this condition. Cystic brain metastases are characterized by larger tumor sizes with increased peritumoral edema compared with solid metastases. Therefore, specific treatment strategies are required for intracranial disease control. Immunotherapy has recently been demonstrated to be crucial for treating pulmonary sarcomatoid carcinomas based on high programmed cell death-ligand 1 (PD-L1) expression observed in these cancers. The present report describes the case of an 82-year-old man diagnosed with pulmonary spindle cell carcinoma, a rare subtype of sarcomatoid carcinoma. At 7 months after the diagnosis, the patient complained of a walking disturbance for which brain metastasis with peritumoral edema was the causative agent. The brain tumor had a large cystic component, and thus, an Ommaya reservoir catheter was implanted for cyst aspiration but collapsed early without sufficient volume reduction. The patient was transferred to receive twice-split gamma knife treatment, which shrank the solid compartment and reduced the cyst volume, thereby relieving neurological defects. The patient was subsequently treated with immunotherapy targeting programmed cell death-1 based on the high PD-L1 expression in the lung tumor specimen. The thoracic tumors regressed following immunotherapy and progression-free survival was maintained for 16 months. To the best of our knowledge, the present report provides the first description of focal and systemic therapies for pulmonary spindle cell carcinoma with cystic brain metastasis. The report also discusses the treatment strategies for cystic brain metastases and reviews cases of pulmonary spindle cell carcinoma treated with immune checkpoint inhibitors.
脑囊性转移瘤是一种罕见的疾病，主要起源于肺或乳腺腺癌。相比之下，肺梭形细胞癌是一种罕见的非小细胞癌类型，尚未有关于其发生这种情况的报道。与实性转移瘤相比，脑囊性转移瘤的特点是肿瘤体积较大，瘤周水肿增加。因此，需要特定的治疗策略来控制颅内疾病。最近的研究表明，基于这些癌症中观察到的高程序性细胞死亡配体1（PD-L1）表达，免疫疗法对于治疗肺肉瘤样癌至关重要。本报告描述了一例82岁男性被诊断为肺梭形细胞癌（一种罕见的肉瘤样癌亚型）的病例。诊断后7个月，患者出现行走障碍，病因是伴有瘤周水肿的脑转移瘤。脑肿瘤有一个大的囊性成分，因此植入了Ommaya储液囊导管进行囊肿抽吸，但早期塌陷，囊肿体积没有充分减小。患者被转至接受分次伽玛刀治疗，该治疗缩小了实性部分并减小了囊肿体积，从而缓解了神经功能缺损。随后，基于肺肿瘤标本中高PD-L1表达，对患者进行了靶向程序性细胞死亡-1的免疫治疗。免疫治疗后胸部肿瘤缩小，无进展生存期维持了16个月。据我们所知，本报告首次描述了针对伴有脑囊性转移的肺梭形细胞癌的局部和全身治疗。该报告还讨论了脑囊性转移瘤的治疗策略，并回顾了用免疫检查点抑制剂治疗的肺梭形细胞癌病例。
