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Vol.50 No.6 contents | Japanese/English |
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- Case Report -
A Case of Pulmonary Pleomorphic Carcinoma Treated with Concurrent Chemoradiotherapy Followed by Successful Tumor Resection
Tatsuya Nishida1, Tomoyoshi Itoh1, Kenichi Minami1, Daisuke Masuda1, Daiki Kobayashi1, Yoshitaka Fujii11Respiratory Center, Ishikiriseiki Hospital, Japan
Background. Pulmonary pleomorphic carcinoma is an aggressive tumor with a poor prognosis. The preoperative diagnosis of this carcinoma is difficult, and thus far, no optimal treatment modality has been established. Case. A 43-year old woman visited a local hospital with unbearable pain extending from the right axillary region to the back in July, 2007. Chest radiography showed an abnormal shadow in the right upper lung field. She was referred to our hospital for further evaluation. Computed tomography of the chest showed an ill-defined 6-cm mass with surrounding ground-glass opacity, accompanied by thickening of the interlobular septa in the right upper lobe of the lung, which invaded the right posterior chest wall. Transbronchial biopsy revealed the possibility of sarcomatoid carcinoma composed of carcinoma cells including giant cells. Systemic examination of the patient did not reveal distant metastasis. The mass was diagnosed as pulmonary pleomorphic carcinoma and the cancer stage was identified as IIB (cT3N0M0) preoperatively. Subsequently, the patient was given preoperative concurrent chemoradiotherapy [radiation therapy (RT), 40 Gy/20 Fr and 3 cycles of chemotherapy with cisplatin (80 mg/m2 on day 1) and vinorelbine (20 mg/m2 on days 1, 8)]. CT revealed that the thickening of the pleura of the right posterior chest wall remained but the solid tumor with surrounding ground-glass opacity in the right upper lobe of the lung had almost completely disappeared. Therefore, preoperative concurrent chemoradiotherapy was considered to have obtained a partial response. We performed right upper lobectomy of the lung, chest wall resection from the 3rd to the 6th rib, and lymph node dissection (ND2a); reconstruction of the chest wall was performed using a Composix Mesh. Postoperative pathological examination revealed residual tumor in the bone, muscle, thickened pleura and lung in the region between the 4th rib and 4th intercostal muscle of the right side. Since there were no complications, the patient was discharged on the 10th postoperative day. The patient is currently alive at 27 months after the operation without signs of recurrence. Conclusion. We report a case of pulmonary pleomorphic carcinoma treated with concurrent chemoradiotherapy followed by successful resection of the tumor. Combined therapy including surgery and chemoradiotherapy for pulmonary pleomorphic carcinoma is important to obtain good outcome, however, further study of similar cases is required.
key words: Primary lung cancer, Pleomorphic carcinoma, Preoperative concurrent chemoradiotherapy, Ground-glass opacity
Received: February 12, 2010
Accepted: August 6, 2010
JJLC 50 (6): 828-834, 2010
