1. 흉부영상집답회 case review
강동경희대병원 이한나

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

4. Small bowel, ileum, segmental resection:

5. 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

8. 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

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

10. Left upper lobe, lobectomy

12. 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

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

14. 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.

15. 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

16. 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):
Clin Lung Cancer Sep;16(5):374-8

17. 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