Personal Experience in Surgical Management of Pulmonary Pleomorphic Carcinoma

doi:10.1016/j.athoracsur.2004.04.084

The Annals of Thoracic Surgery

Volume 78, Issue 5, November 2004, Pages 1742-1747

https://doi.org/10.1016/j.athoracsur.2004.04.084 Get rights and content

Abstract

Background

Pleomorphic carcinoma is a rare epithelial malignant tumor. Pulmonary pleomorphic carcinoma was introduced by the 1999 World Health Organization classification as a new peculiar type of lung carcinoma showing concurrent malignant epithelial and sarcomatoid spindle cell elements. Few reports describe its clinical behavior. My colleagues and I report a series of patients surgically treated for pulmonary pleomorphic carcinoma to describe our experience with this malignant neoplasm.

Methods

Twenty cases of pleomorphic pulmonary carcinoma were collected and studied clinicopathologically. All patients underwent surgical resection. The cases were as follows: 6 stage I, 12 stage II, and 2 stage IIIA. Histologic diagnosis was established by using light microscopic examination and immunohistochemistry. Survival rates were calculated with the Kaplan-Meier method.

Results

We postoperatively diagnosed 20 cases of pleomorphic carcinoma: 14 cases were exclusively spindle and giant-cell carcinomas, 2 cases were spindle and giant-cell carcinoma combined with adenocarcinoma, 2 were combined with squamous cell carcinoma, and 2 were combined with large cell carcinoma. At last follow-up, 4 patients were still alive; they were postoperative T1 N0 and T2 N0. The remaining 16 patients died from early distant metastases. The median duration of disease-free survival was 5 months. The median duration of overall survival was 8 months.

Conclusions

The prognosis of patients with pleomorphic carcinoma was poor, despite surgery and adjuvant chemotherapy, because of early relapse of disease. Nodal involvement was a determinant prognostic variable, because advanced stages were related to worse prognosis. In case of preoperatively proven pulmonary pleomorphic carcinoma, surgery should be recommended to N0 patients.

Section snippets

Patients and Methods

From the beginning of 1999 to the end of 2002, 513 patients underwent surgical resection for primary lung carcinoma at the Department of Thoracic Surgery, University of Milan. Of these, 20 cases were primary pleomorphic carcinoma. The 20 patients with pleomorphic carcinoma were registered for age, sex, presenting symptoms, smoking habits, and stage. There were 14 men and 6 women. The mean age at diagnosis was 60.3 years (range, 43 to 76 years); 80% of patients smoked.

Eighteen patients presented

Results

Clinical data were tabulated according to histologic findings, pathologic tumor-node-metastasis staging, and clinical disease behavior (Table 1). The tumors ranged from 2.1 to 9 cm. Nineteen lesions were intraparenchymal, and 8 showed intrabronchial components in the tumor.

Twenty cases of primary pulmonary pleomorphic carcinoma were identified. Six cases had identifiable epithelial components. Fourteen cases were classified as pure pleomorphic carcinomas consisting only of spindle and giant

Comment

Pulmonary pleomorphic cell carcinoma is a rare malignant lung tumor. This rarity has made its classification confusing and its diagnosis difficult. Before 1999 this tumor was classified as a variant of squamous cell carcinoma. In 1999 the WHO reclassified the pleomorphic carcinoma and set widely adopted criteria. According to these criteria, pleomorphic carcinoma is now considered a peculiar type of lung carcinoma. We reported our clinical experience with pulmonary pleomorphic carcinoma to add

Acknowledgements

The authors are grateful for the valuable collaboration of Alberto G. L. Luporini, MD, Director of the Division of Medical Oncology, Policlinico San Donato Institute, San Donato Milanese, Milan, Italy.

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Original article: general thoracicPersonal Experience in Surgical Management of Pulmonary Pleomorphic Carcinoma

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comment

Acknowledgements

J Thorac Cardiovasc Surg

Chest

Chest

Spindle cell carcinoma of the gingivareport of an autopsy case

J Oral Pathol Med

Sarcomatoid carcinoma of urinary bladder. Clinicopathologic analysis of 18 cases with immunohistochemical and electron microscopic findings

Am J Surg Pathol

Histological typing of lung tumors and pleural tumors

Pleomorphic (giant and spindle cell) carcinoma is genetically distinct from adenocarcinoma and squamous cell carcinoma by K-ras-2 and p53 analysis

Am J Clin Pathol

Significance of p53 and Rb protein expression in surgically treated non small cell lung cancers

Ann Thorac Surg

Histological typing of lung tumors

The new World Health Organization classification of lung tumours

Eur Respir J

Original article: general thoracic
Personal Experience in Surgical Management of Pulmonary Pleomorphic Carcinoma