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Vol.42 No.1 contents | Japanese/English |
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- Case Report -
A Case of Pulmonary Adenocarcinoma Accompanied by Sarcomatous Findings (Pleomorphic Carcinoma, WHO), With Special Reference to the Growth Potentiality
Ken-ichiro Minami1, Yukihito Saito1, Hideyasu Ohmiya1, Hiroji Imamura1, Noriko Sakaida2, Akiharu Okamura3Department of 1Thoracic and Cardiovascular Surgery and 2Surgical Pathology, Kansai Medical University Hospital, Japan, 3International Center for Diagnostic Pathology, Japan
Background. The biological characteristics of pulmonary carcinoma with sarcomatoid elements are not well known. We report an uncommon case of adenocarcinoma with sarcomatoid findings (classification of the Japan Lung Cancer Society-JLCS) or pleomorphic carcinoma (WHO), with special reference to biological characteristics evaluated by the immunohistochemistry using cytokeratin, epithelial membrane antigen, vimentin and Ki-67 (MIB-1). Case. A 75-year-old man consulted us about an abnormal shadow near the right hilum on chest X-ray. Brushing cytology showed adenocarcinoma cells of the lung. Bilobectomy was performed, because the tumor (25×22 mm) was located in peripheral S5 and invaded directly into the upper lobe. The TNM staging of the tumor was pT2N0M0, stage IB. Histopathologically, the main components of the tumor appeared to be sarcomatoid spindle cells (positive for cytokeratin) with mild lymphocytic infiltrates. In any other part, foci of conventional moderately differentiated adenocarcinoma were identified. Additionally, foci of adenocarcinoma and sarcomatoid components were intermingled with each other. This tumor was diagnosed as adenocarcinoma with sarcomatous findings (JLCS) or pleomorphic carcinoma (WHO). Immunohistochemically, cytokeratin was positive in both components, EMA (epithelial membrane antigen) in adenocarcinoma component, and peculiarly Ki-67 labelled cells in the sarcomatoid component were more numerous than those in the adenocarcinoma. Conclusions. 1. An operated case of pleomorphic carcinoma was reported. 2. Immunohistologically, Ki-67 labelled cells in sarcomatoid components were distinctly more numerous than those in adenocarcinoma. 3. We conclude that the tumor cells located in the sarcomatoid components are cells transforming into more poorly differentiated and highly proliferative cells than those of the adenocarcinoma components.
key words: Pleomorphic carcinoma, Adenocarcinoma, Sarcomatoid element, Immunohistochemistry, Ki-67
Received: May 25, 2001
Accepted: November 13, 2001
JJLC 42 (1): 29-33, 2002
