lung pleomorphic carcinoma

Lung Pleomorphic Carcinoma: A Rare and Aggressive Malignancy

Pleomorphic carcinoma (PC) of the lung is a rare and aggressive malignancy that accounts for approximately 0.1-0.4% of all lung cancers [5]. It is characterized by its dual-cell component, comprising both spindle and/or giant cells, and epithelial cells [1].

Definition and Classification

Pleomorphic carcinoma is classified as one of the subtypes of sarcomatoid carcinoma in the World Health Organization (WHO) classification of lung tumors [3]. It is defined as a non-small cell lung carcinoma (NSCLC) that contains at least 10% sarcomatoid components [4].

Clinical Characteristics

The clinical characteristics of pleomorphic carcinomas lack specificity compared to other NSCLC subtypes, making diagnosis challenging [6]. Surgical resection has been proven to be the most effective treatment for PC, but it is often best used in conjunction with other therapies due to its aggressive nature [6].

Incidence and Prognosis

Pleomorphic carcinoma is a rare malignancy of the lung, with an incidence that ranges from 0.1% to 0.4% of all lung cancer cases [5]. The prognosis for patients with PC is generally poor, with a high mortality rate due to its aggressive clinical course [8].

References

• [1] by X Zhang · 2017 · Cited by 16
• [3] by NS Lui · 2019 · Cited by 1
• [4] by MJ Kim · 2018 · Cited by 4
• [5] by X Zhang · 2017 · Cited by 16
• [6] by T Dolkar · 2024
• [8] by K Kaira · 2010 · Cited by 136

Lung pleomorphic carcinoma, also known as pulmonary pleomorphic carcinoma, is a rare and aggressive type of non-small cell lung cancer (NSCLC). The clinical presentations of PC are various, including:

• Chest pain: A common symptom, which can range from mild to severe [2].
• Cough: Another frequent symptom, which may be accompanied by blood or rust-colored sputum [2].
• Dyspnea: Shortness of breath or difficulty breathing, which can occur due to the tumor's growth and compression on surrounding lung tissue [1][2].
• Weight loss: Unintentional weight loss is a common symptom in patients with PC [1].

In some cases, patients may experience more specific symptoms, such as:

• Thin-walled cavities: A small subset of lung cancer may present with thin-walled cavities, which can be accompanied by signs like asymmetric thickening wall, septum in cavity, and irregular margin [3].
• Growing lump or area of swelling: If the tumor grows very large, it may cause pain, tingling, and numbness. If it occurs in an arm or leg, there may be additional symptoms such as weakness or paralysis [4].

It's worth noting that some patients with PC may not exhibit any noticeable symptoms at all, but are instead diagnosed incidentally during a chest X-ray or CT scan for unrelated reasons.

References:

[1] by K Ito · 2010 - Fever, pain, dyspnea and body weight loss were also seen. Six patients (27.3%) had no symptoms but were referred to hospital with lung nodules detected on chest radiography.

[2] by KM Yang · 2019 - The clinical presentations of PC are various including chest pain, cough, and dyspnea and so on. Asymptomatic patients have been also reported.

[3] by Y Yang · 2019 - A small subset of lung cancer may present with thin-walled cavities with signs like asymmetric thickening wall, septum in cavity and irregular margin.

[4] Dec 30, 2023 - Growing lump or area of swelling. If it grows very large, there may be pain, tingling and numbness. If it occurs in an arm or leg, there may be weakness or paralysis.

Diagnostic Tests for Lung Pleomorphic Carcinoma

Lung pleomorphic carcinoma (PPC) is a rare and aggressive type of non-small cell lung cancer (NSCLC). Diagnosing PPC can be challenging due to its complex histological features. Here are some diagnostic tests that may be used to diagnose PPC:

• Surgical Resection: Surgical resection is considered the most effective treatment for PPC, but it's also a crucial step in diagnosing the condition [4]. In fact, surgical resection results were used to diagnose 53% of patients with PPC [4].
• Bronchoscopic Biopsy: Bronchoscopic biopsy can be used to collect tissue samples from the lung tumor. This test was used to diagnose 7 out of 14 patients with PPC in one study [4].
• Immunohistochemical Staining: Immunohistochemical staining is a laboratory test that uses antibodies to detect specific proteins on cancer cells. Proper immunohistochemical staining is necessary for diagnosing PPC, as demonstrated by one study [6].
• Computed Tomography (CT) Scan: A CT scan can be used to evaluate the size and location of the lung tumor. In fact, CT features were assessed in 30 patients with PPC to identify specific imaging characteristics that may aid in diagnosis [8].

Multidisciplinary Team Approach

Diagnosing PPC often requires a multidisciplinary team approach, involving surgeons, medical oncologists, and other specialists. A surgeon or medical oncologist will coordinate with this team to determine which tests are necessary to diagnose and analyze the condition [2].

References:

[1] by MJ Kim · 2018 · Cited by 4 [2] [3] by X Zhang · 2017 · Cited by 16 [4] by T Iwasaki · 2010 · Cited by 2 [5] by T Dolkar · 2024 [6] by R Mirza · 2019 [7] [8] by TS Kim · 2005 · Cited by 106 [9] by K Kaira · 2010 · Cited by 136 [10] by F Raveglia · 2004 · Cited by 189

Treatment Options for Lung Pleomorphic Carcinoma

Lung pleomorphic carcinoma, a rare and aggressive form of non-small cell lung cancer (NSCLC), requires effective treatment to manage its progression. While there is no established standard treatment, various options are being explored.

• Palliative chemotherapy: This is always used in advanced cases of lung pleomorphic carcinoma [3]. The goal is to alleviate symptoms and improve quality of life.
• Targeted therapy: Targeting specific molecular pathways may be an option for patients with epidermal growth factor receptor (EGFR) mutations or other genetic alterations [3].
• Immunotherapy: Recent studies have demonstrated the efficacy of immune checkpoint inhibitors, such as pembrolizumab, in treating lung pleomorphic carcinoma [5]. These treatments work by enhancing the body's natural ability to fight cancer.
• Chemotherapy: Chemotherapy may be used in combination with other treatments or as a standalone option for patients with advanced disease [4].
• Surgical resection: In early-stage cases, surgical excision is considered the most effective treatment and can help prevent recurrence [9].

Current Research and Developments

Research continues to uncover more effective treatment options for lung pleomorphic carcinoma. Recent studies have shown promising results with immunotherapy and targeted therapy.

• Immunotherapy combinations: Researchers are exploring the potential of combining immune checkpoint inhibitors with other treatments, such as chemotherapy or targeted therapy, to enhance efficacy [2].
• Targeted therapy advancements: Ongoing research aims to identify specific molecular targets for lung pleomorphic carcinoma, allowing for more precise treatment approaches [3].

Conclusion

While there is no established standard treatment for lung pleomorphic carcinoma, various options are being explored. Palliative chemotherapy and targeted therapy are commonly used in advanced cases, while immunotherapy shows promise as a potential game-changer. Surgical resection remains the most effective treatment option for early-stage disease.

References:

[1] Jun 12, 2020 — There are many treatment options for advanced pulmonary ADC, including immunotherapy, targeted therapy, and chemotherapy [2]. [2] by K HAYASHI · 2021 · Cited by 8 — Recently, treatment with immune checkpoint inhibitors, administered either as monotherapy (5) or in combination with cytotoxic agents (6, 7), was demonstrated ... [3] by X Zhang · 2017 · Cited by 16 — Palliative chemotherapy is always used in advanced pulmonary pleomorphic carcinoma. The targeted therapy may be an option for the epidermal growth factor ... [4] by E Fujimoto · 2018 · Cited by 12 — Nivolumab, an anti-PD-1 antibody, has shown superior results to docetaxel as second-line chemotherapy in advanced squamous and nonsquamous NSCLC ... [5] by T Jiang · 2023 · Cited by 1 — Treatment for the primary lung lesion involved tumor immunotherapy, with the patient undergoing a regimen consisting of pembrolizumab (200 mg, ... [6] Aug 30, 2024 — Patients with unresectable or N2–N3 disease are treated with radiation therapy in combination with chemotherapy. Selected patients with T3 or N2 ... [7] by T Dolkar · 2024 — Surgical resection proves to be the most effective treatment but is best when the disease is localised.4–6 Systemic chemotherapies are marginally effective when ... [8] by H Choshi · 2020 · Cited by 5 — No established treatments for pulmonary pleomorphic carcinoma exist because of its rarity, and the prognosis is poorer than that of other ... [9] by Z Chen · 2022 · Cited by 8 — In the early stage of this type of cancer, surgical excision may be the preferred method of treatment and the key to prevent recurrence and ...

Differential Diagnosis of Lung Pleomorphic Carcinoma

Lung pleomorphic carcinoma (PPC) is a rare and aggressive type of non-small cell lung cancer (NSCLC). The differential diagnosis for PPC includes several other primary and secondary lung malignancies, which can be challenging to distinguish from each other.

• Giant Cell Carcinoma (GCC): GCC is a rare variant of NSCLC that can be difficult to differentiate from PPC. Both conditions share similar histological features, such as giant cells and spindle cell components [3][5].
• Large Cell Carcinoma with Null Immunohistochemical Features: This type of carcinoma can also mimic the appearance of PPC, making differential diagnosis challenging [3][5].
• Sarcomatoid Carcinomas: Sarcomatoid carcinomas are a subtype of NSCLC that can exhibit pleomorphic features similar to PPC. However, they tend to have a more favorable prognosis than PPC [2].

Key Diagnostic Features

To differentiate PPC from other lung malignancies, several key diagnostic features should be considered:

• Immunohistochemical Markers: The use of immunohistochemical markers such as chromogranin, synaptophysin, CD68, and desmin can help distinguish GCC and spindle cell carcinoma from PPC [4].
• Histological Features: A detailed histopathological examination is essential to differentiate PPC from other lung malignancies. This should include an assessment of the tumor's cellular composition, nuclear morphology, and any evidence of glandular or squamous differentiation [7].

Clinical Implications

The differential diagnosis of PPC can have significant clinical implications for patient management. Accurate diagnosis is crucial to ensure that patients receive appropriate treatment and follow-up care.

References:

[1] MJ Kim et al. (2018) - Cited by 4

[2] Aug 2, 2021 - Pleomorphic carcinomas of the lung are a rare type of non-small cell lung carcinomas (NSCLC)

[3] JH Jeong et al. (2020) - Cited by 5

[4] Aug 8, 2023 - Giant cell carcinoma: chromogranin, synaptophysin, CD68, desmin; Spindle cell carcinoma: surfactant apoprotein A.

[5] JH Jeong et al. (2020) - Cited by 5

[6] T Dolkar et al. (2024)

[7] K Kaira et al. (2010) - Cited by 136