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- Case Report -

A Case of Lung Pleomorphic Carcinoma with an EML4-ALK Mutation Presenting as Ground-glass Attenuation Around the Tumor

Noritaka Kikuchi¹, Haruhiro Saito¹, Tetsuya Isaka², Hiroyuki Ito², Tomoyuki Yokose³, Kozo Yamada^1
1Department of Thoracic Oncology, ²Department of Thoracic Surgery, ³Department of Pathology, Kanagawa Cancer Center, Japan

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Background. Lung pleomorphic carcinomas are a rare form of lung cancer. There are few reports about the CT findings in this type of cancer. We herein report a rare case that presented the characteristic CT findings. CT revealed areas of ground-glass attenuation (GGA) around the tumor, which reflected the area of bleeding from the tumor. An EML4-ALK mutation was detected in the tumor. The Case. The patient of the present case was a 44-year-old male. He presented with continuous bloody sputum and a lung tumor of 20 mm in diameter in the right lower lobe. A bronchofiberscopic examination revealed a suspected pleomorphic carcinoma which contained adenocarcinoma components. The thin-section CT findings included demarcated GGA around the whole circumference of the tumor. It was hypothesized that this finding reflected the replacement growth pattern of the adenocarcinoma component of the tumor. A histopathological examination of a surgical specimen demonstrated that the tumor was a pleomorphic lung carcinoma, which consisted of adenocarcinoma and spindle cell components (pT1bN2M0). Areas of bleeding, which were observed as areas of GGA on CT and which appeared at various time phases were observed around the tumor. An EML4-ALK mutation was detected in the tumor tissue. Conclusion. We reported the unique characteristic CT findings of pleomorphic carcinoma. Areas of GGA around the tumor reflected the areas in which bleeding occurred at various time phases.
key words: Lung pleomorphic carcinoma, Bleeding, Ground-glass attenuation, GGA, CT

Received: August 23, 2015
Accepted: December 29, 2015

JJLC 56 (2): 98-102, 2016