Clinical Management of Pulmonary Pleomorphic Carcinoma：Report of 7 Cases and Literature Review_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHEN Cheng , CHE Guowei.

Department of Thoracic Surgery，　West China Hospital of Sichuan University，　Chengdu 610041，　P. R. China;

Corresponding author：

Keywords：

Pulmonary pleomorphic carcinoma; 　Surgery; 　Prognosis

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Abstract：　Objective　To investigate clinical characteristics， surgical strategy and prognosis of pulmonary pleomorphic carcinoma， and improve the diagnostic and therapeutic level of pulmonary pleomorphic carcinoma.　Methods　We retrospectively analyzed clinical data of 7 patients with pulmonary pleomorphic carcinoma who underwent surgical resection from January 2006 to August 2011 in West China Hospital of Sichuan University. There were 5 male patients and 2 female patients with the male/female ratio of 2.5︰1.0 and the mean age of 58.85 （43-69） years old. We also conducted a literature review through PubMed using pulmonary pleomorphic carcinoma and surgery as the key words， and 8 patients with integral clinical data from 2005 to 2011 were identified. There were 7 male patients and 1 female patient with the male/female ratio of 7︰1 and mean age of 70.25 （51-79） years old. All the patients underwent surgical resection and systemic lymph node dissection.　Results　The mean age of this group was 64.93 （43-79） years old. Among the 15 patients， there were 12 males and 3 females with the male/female ratio of 4︰1. The main symptoms were cough， blood in phlegm， hemoptysis and chest pain. Pathology diagnosis confirmed pleomorphic carcinoma in all the patients. Among the 7 patients of our hospital， there were 3 patients with spindle cell with squamous cell carcinoma， 2 patients with spindle cell with adenocarcinoma， and 2 patients with spindle cell with large cell carcinoma and adenocarcinoma. During follow-up， 3 patients died with the longest survival time of 49 months， and the other 4 patients were still alive. Among the 8 patients in the literature review， there were 4 patients with spindle cell with squamous cell carcinoma， 1 patient with spindle cell with adenocarcinoma， 1 patient with spindle cell with large cell carcinoma and squamous cell carcinoma, and 2 patients with spindle cell with adenocarcinoma and squamous cell carcinoma. During follow-up， 5 patients died with the longest survival time of 22 months， and the other 3 patients were still alive.　Conclusion　Pulmonary pleomorphic carcinoma is extremely rare and surgical resection is an effective treatment strategy for it.

Citation： SHEN Cheng,CHE Guowei.. Clinical Management of Pulmonary Pleomorphic Carcinoma：Report of 7 Cases and Literature Review. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 634-637. doi: Copy

1.	Beasley MB， Brambilla E， Travis WD. The 2004 World Health　rganization classification of lung tumors. Semin Roentgenol， 2005， 40 （2）：90-97.
2.	Brambilla E， Travis WD， Colby TV， et al. The new World Health Organization classification of lung tumours. Eur Respir J， 2001， 18 （6）：1059-1068.
3.	Travis WD， Travis LB， Devesa SS. Lung cancer. Cancer， 1995， 75 （1）：191-202.
4.	Travis WD. Pathology of lung cancer. Clin Chest Med ， 2011， 32 （4）：669-692.
5.	Yuki T， Sakuma T， Ohbayashi C， et al. Pleomorphic carcinoma of the lung： a surgical outcome. Thorac Cardiovasc Surg， 2007， 134 （2）：399-404.
6.	张悦，郭雪君，韩锋锋，等. 肺肉瘤样癌2例并文献复习. 临床肺科杂志， 2011， 16 （6）：900-902.
7.	Fujioka S， Nakamura H， Adachi Y， et al. Pleomorphic carcinoma of the lung in which the sarcomatous element grew rapidly： A case report. Ann Thorac Cardiovasc Surg， 2009， 15 （2）：111-114.
8.	Arita N， Mikami Y， Yoshida M， et al. Plemorphic carcinoma of the lung associated with loss of heterozygosity of p53 gene. Tohoku J Exp Med， 2005， 206 （2）：181-185.
9.	Kikuchi R， Isowa N， Tokuyasu H， et al. Three cases of resected pleomorphic carcinoma. Ann Thorac Cardiovasc Surg， 2010， 16 （4）：264-269.
10.	Goto T， Maeshima A， Kato R. Combined large cell neuroendocrine carcinoma and spindle cell carcinoma of the lung. Jpn J Clin Oncol， 2011， 41 （6）：797-802.
11.	Travis WD， Brambilla E， Muller-Hermelink GK， et al. World Health Organization classification of tumours， Pathology and　Genetics of Tumours of the Lung， Pleura， Thymus and Heart. Lyon： IARC Press， 2004. 9-124.
12.	Rossi G， Cavazza A， Sturm N， et al. Pulmonary carcinomas with pleomorphic， sarcomatoid， or sarcomatous elements： a clinicopathologic and immunohistochemical study of 75 cases. Am J Surg Pathol， 2003， 27 （3）：311-324.
13.	Raveglia F， Mezzetti M， Panigalli T， et al. Personal experience in surgical management of pulmonary pleomorphic carcinoma. Ann Thorac Surg， 2004， 78 （5）：1742-1747.
14.	Kim TS， Han J， Lee KS， et al. CT findings of surgically resected pleomorphic carcinoma of the lung in 30 patients. Am J Roentgenol， 2005， 185 （1）：120-125.
15.	Bae HM， Min HS， Lee SH， et al. Palliative chemotherapy for pulmonary pleomorphic carcinoma. Lung Cancer， 2007， 58 （1）：112-115.
16.	Mochizuki T， Ishii G， Nagai K， et al. Pleomorphic carcinoma of the lung： clinicopathologic characteristics of 70 cases .Am J Surg Pathol， 2008， 32 （11）：1727-1735.
17.	李惠章，李威，杨重庆，等. 肺肉瘤样癌的X 线胸片和CT 表现. 中华放射学杂志， 2007， 41 （7）：694-697.
18.	Litzky LA. Pulmonary sarcomatous tumors. Arch Pathol Lab Med， 2008， 132 （7）：1104-1117.
19.	Chang YL， Lee YC， Sh ih JY， et al. Pulmonary pleomorphic （spindle） cell carcinoma： peculiar clinicopathologic manifestation different from ordinary non-small cell carcinoma. Lung Cancer， 2001， 34 （1）：91-97.
20.	涂宁芳，薛从容. 肺多形性癌6例临床病理和免疫组化分析. 肿瘤防治研究， 2006， 33 （2）：113-114.
21.	Yoo SH， Han J， Kim TJ， et al. Expression of CD99 in pleomorphic carcinoma of the lung. J Korean Med Sci， 2005， 20 （1）：50-55.
22.	Kim TH， Kim SJ， Ryu YH， et al. Pleomorphic Carcinoma of Lung： Comparison of CT Features and Pathologic Findings. Radiology， 2004， 232 （2）：554-559.
23.	成向阳，熊信国，邱源，等. 胸腔镜辅助小切口治疗多形性肺癌28例疗效观察. 中国肺癌杂志， 2010， 13 （8）：813-816.
24.	Ito K， Oizumi S， Fukumoto S， et al. Clinical characteristics of pleomorphic carcinoma of the lung. Lung Cancer， 2010， 68 （2）：204-210.
25.	Martin LW， Correa AM， Ordonez NG， et al. Sarcomatoid carcinoma of the lung： a predictor of poor prognosis. Ann Thorac Surg， 2007， 84 （3）：973-981.
26.	Venissac N， Pop D， Lassalle S， et al. Sarcomatoid lung cancer （spindle/giant cells）：an aggressive disease. Thorac Cardiovasc Surg， 2007， 134 （3）：619-623.
27.	Nakajima M， Kasai T， Hashimoto H， et al. Sarcomatoid carcinoma of the lung A clinicopathologic study of 37 cases. Cancer， 1999， 86 （4）：608-616.

1. 　Beasley MB， Brambilla E， Travis WD. The 2004 World Health　rganization classification of lung tumors. Semin Roentgenol， 2005， 40 （2）：90-97.
2. 　Brambilla E， Travis WD， Colby TV， et al. The new World Health Organization classification of lung tumours. Eur Respir J， 2001， 18 （6）：1059-1068.
3. 　Travis WD， Travis LB， Devesa SS. Lung cancer. Cancer， 1995， 75 （1）：191-202.
4. 　Travis WD. Pathology of lung cancer. Clin Chest Med ， 2011， 32 （4）：669-692.
5. 　Yuki T， Sakuma T， Ohbayashi C， et al. Pleomorphic carcinoma of the lung： a surgical outcome. Thorac Cardiovasc Surg， 2007， 134 （2）：399-404.
6. 　张悦，郭雪君，韩锋锋，等. 肺肉瘤样癌2例并文献复习. 临床肺科杂志， 2011， 16 （6）：900-902.
7. 　Fujioka S， Nakamura H， Adachi Y， et al. Pleomorphic carcinoma of the lung in which the sarcomatous element grew rapidly： A case report. Ann Thorac Cardiovasc Surg， 2009， 15 （2）：111-114.
8. 　Arita N， Mikami Y， Yoshida M， et al. Plemorphic carcinoma of the lung associated with loss of heterozygosity of p53 gene. Tohoku J Exp Med， 2005， 206 （2）：181-185.
9. 　Kikuchi R， Isowa N， Tokuyasu H， et al. Three cases of resected pleomorphic carcinoma. Ann Thorac Cardiovasc Surg， 2010， 16 （4）：264-269.
10. 　Goto T， Maeshima A， Kato R. Combined large cell neuroendocrine carcinoma and spindle cell carcinoma of the lung. Jpn J Clin Oncol， 2011， 41 （6）：797-802.
11. 　Travis WD， Brambilla E， Muller-Hermelink GK， et al. World Health Organization classification of tumours， Pathology and　Genetics of Tumours of the Lung， Pleura， Thymus and Heart. Lyon： IARC Press， 2004. 9-124.
12. 　Rossi G， Cavazza A， Sturm N， et al. Pulmonary carcinomas with pleomorphic， sarcomatoid， or sarcomatous elements： a clinicopathologic and immunohistochemical study of 75 cases. Am J Surg Pathol， 2003， 27 （3）：311-324.
13. 　Raveglia F， Mezzetti M， Panigalli T， et al. Personal experience in surgical management of pulmonary pleomorphic carcinoma. Ann Thorac Surg， 2004， 78 （5）：1742-1747.
14. 　Kim TS， Han J， Lee KS， et al. CT findings of surgically resected pleomorphic carcinoma of the lung in 30 patients. Am J Roentgenol， 2005， 185 （1）：120-125.
15. 　Bae HM， Min HS， Lee SH， et al. Palliative chemotherapy for pulmonary pleomorphic carcinoma. Lung Cancer， 2007， 58 （1）：112-115.
16. 　Mochizuki T， Ishii G， Nagai K， et al. Pleomorphic carcinoma of the lung： clinicopathologic characteristics of 70 cases .Am J Surg Pathol， 2008， 32 （11）：1727-1735.
17. 　李惠章，李威，杨重庆，等. 肺肉瘤样癌的X 线胸片和CT 表现. 中华放射学杂志， 2007， 41 （7）：694-697.
18. 　Litzky LA. Pulmonary sarcomatous tumors. Arch Pathol Lab Med， 2008， 132 （7）：1104-1117.
19. 　Chang YL， Lee YC， Sh ih JY， et al. Pulmonary pleomorphic （spindle） cell carcinoma： peculiar clinicopathologic manifestation different from ordinary non-small cell carcinoma. Lung Cancer， 2001， 34 （1）：91-97.
20. 　涂宁芳，薛从容. 肺多形性癌6例临床病理和免疫组化分析. 肿瘤防治研究， 2006， 33 （2）：113-114.
21. 　Yoo SH， Han J， Kim TJ， et al. Expression of CD99 in pleomorphic carcinoma of the lung. J Korean Med Sci， 2005， 20 （1）：50-55.
22. 　Kim TH， Kim SJ， Ryu YH， et al. Pleomorphic Carcinoma of Lung： Comparison of CT Features and Pathologic Findings. Radiology， 2004， 232 （2）：554-559.
23. 　成向阳，熊信国，邱源，等. 胸腔镜辅助小切口治疗多形性肺癌28例疗效观察. 中国肺癌杂志， 2010， 13 （8）：813-816.
24. 　Ito K， Oizumi S， Fukumoto S， et al. Clinical characteristics of pleomorphic carcinoma of the lung. Lung Cancer， 2010， 68 （2）：204-210.
25. 　Martin LW， Correa AM， Ordonez NG， et al. Sarcomatoid carcinoma of the lung： a predictor of poor prognosis. Ann Thorac Surg， 2007， 84 （3）：973-981.
26. 　Venissac N， Pop D， Lassalle S， et al. Sarcomatoid lung cancer （spindle/giant cells）：an aggressive disease. Thorac Cardiovasc Surg， 2007， 134 （3）：619-623.
27. 　Nakajima M， Kasai T， Hashimoto H， et al. Sarcomatoid carcinoma of the lung A clinicopathologic study of 37 cases. Cancer， 1999， 86 （4）：608-616.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Management of Pulmonary Pleomorphic Carcinoma：Report of 7 Cases and Literature Review

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