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Vol.55 No.3 contents

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- Case Report -

A Suspected Case of Pulmonary Pleomorphic Carcinoma Diagnosed by Resected Small Intestine Metastasis

Kyoko Gocho¹, Kazutoshi Isobe¹, Hiroshige Shimizu¹, Satoshi Matsuda², Naobumi Tochigi³, Sakae Homma^1
1Department of Respiratory Medicine, ²Department of Gastroenterological Surgery, ³Department of Surgical Pathology, Toho University Omori Medical Center, Japan

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Background. Pulmonary pleomorphic carcinoma, a rare form of poorly differentiated carcinoma, has sarcomatoid components, including spindle cells and giant cells. Making a definite pathological diagnosis is difficult using transbronchial biopsied specimens. Case. A 73-year-old man was admitted to our hospital with a fever and abdominal pain. Computed tomography showed a mass shadow in the left upper lobe of the lung and multiple masses in the small intestine. A bronchoscopic biopsy of the lung mass revealed poorly differentiated carcinoma. An endoscopic biopsy of the abdominal tumors revealed poorly differentiated carcinoma in the small intestine. Immunostaining confirmed that the lung lesion was the primary cancer site. Because of the high risk of ileus and perforation, partial resection of the small intestine was performed. Surgery revealed three metastases in the small intestine, one of which showed penetration and invasion of the transverse colon and invasion to the urinary bladder and abdominal wall. A histopathological analysis showed that the metastases in the small intestine had sarcomatous components, consisted of spindle cells and giant cells, and poorly differentiated carcinoma cells, which confirmed the diagnosis of pulmonary pleomorphic carcinoma. Conclusion. In this case, it was difficult to diagnose this patient based on a transbronchial tumor biopsy of the primary site alone. Pulmonary pleomorphic carcinoma should be considered in the differential diagnosis in the cases with a persistent antibiotic-resistant fever and gastrointestinal metastasis with an increase in the levels of inflammatory markers. Resection of the metastasis is necessary before the patient develops a severe condition.
key words: Primary lung cancer, Pulmonary pleomorphic carcinoma, Small intestine metastasis

Received: January 7, 2015
Accepted: May 21, 2015

JJLC 55 (3): 176-182, 2015