흉부영상집답회 case review 강동경희대병원 이한나

CASE 63/M C.C. : abdominal pain, melena

Small bowel, ileum, segmental resection:

Small bowel, ileum, segmental resection: Consistent with GIANT CELL CARCINOMA 1) Size: 5.8 x 5.5 x 3.2 cm 2) Invasion up to subserosa 3) No angiolymphatic emboli 4) Negative resection margins (proximal: 12.5 cm, distal: 17 cm) 5) No metastasis in 11 lymph nodes

2016-07-25

2016-07-25

Lung, left lobe, percutaneous needle biopsy: maxSUV 17 Lung, left lobe, percutaneous needle biopsy: ADENOCARCINOMA, POORLY DIFFERENTIATED SPECIAL & IMMUNOHISTOCHEMICAL STAIN CK 20 : negative CK 7 : positive P63 : positive TTF-1 : positive 2016-08-01

? vs. + ? adenocarcinoma giant cell carcinoma giant cell carcinoma

Left upper lobe, lobectomy

Pathology Lung, upper lobe, left, lobectomy: PLEOMORPHIC CARCINOMA 1) Location: Peripheral 2) Size: 8 x 8 x 6 cm 3) Tumor components - Carcinoma area: poorly differentiated adenocarcinoma - Sarcomatoid area: giant cells 4) Tumor invades to the parietal pleura (PL3) 5) No metastasis in 28 regional lymph nodes (0/28) SPECIAL & IMMUNOHISTOCHEMICAL STAIN CK, AE1/AE3 : positive TTF-1 : positive VIMENTIN : positive Napsin A : positive P40 : negative

Pleomorphic carcinoma with small bowel metastasis adenocarcinoma giant cell carcinoma Pleomorphic carcinoma with small bowel metastasis

Pleomorphic carcinoma of the lung WHO classification non–small cell lung cancer + spindle or giant cells carcinoma consisting only of spindle and giant cells 0.1%–0.4% of all lung malignancies, heavily smoker Image findings large, frequently peripheral, necrotic mass, mainly involved upper lobes peritumoral area of ground-glass attenuation AJR Am J Roentgenol. 2005 Jul;185(1):120-5. Radiology. 2004 Aug;232(2):554-9.

Various metastasis site Worse prognosis than conventional non–small cell lung cancer at surgically curable stage I pleural and vascular invasion PC (48% and 83%), NSCLCs (22% and 34%) Various metastasis site thyroid grand, peritoneum, lymph nodes of abdomen, small bowel Lung Cancer. 2010 May;68(2):204-10

Preoperative diagnosis Most commonly, carcinomatous and sarcomatoid components directly abutted on each other, and there were areas of blending between them The diagnosis of pleomorphic carcinoma cannot be made on small biopsies or cytology Transbronchial lung biopsy of 126 lung cancer 19 case – conflicted larger tumor size and poor differentiation grade Lung Cancer. 2001 Oct;34(1):91-7. J Thorac Oncol. 2015 Sep;10(9):1243-60. Clin Lung Cancer. 2015 Sep;16(5):374-8

Metastasis from pleomorphic carcinoma 11 cases of carcinosarcoma, 12 cases of pleomorphic carcinoma exclusive or partial epithelial composition in 83% pure mesenchymal composition in 17% Epithelial cells could contribute more effectively than sarcomatous elements experimentally in murine models lack of prognostic implications of percentage of sarcomatoid component in the primary tumors Int J Surg Pathol. 2010 Apr;18(2):103-2