Pleomorphic Spindle and Giant Cell Carcinoma of Lung With Widespread Metastases: An Autopsy Case Report. (21st September 2018)

• Record Type: Journal Article
• Authors: Derakhshandeh, Roshanak; Maldonado, Leonel; Roveda, Kelly
• Is Part Of: American journal of clinical pathology. Volume 150(2018)Supplement 1
• Page Start: S56
• Page End: S57
• Publication Date: 2018-09-21
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqy091.139
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Pleomorphic spindle and giant cell carcinoma (PC) is a rare, poorly differentiated non–small cell lung carcinoma that contains at least 10% spindle and/or giant cells and currently grouped among sarcomatoid carcinomas of the lung by the 2015 World Health Organization classification of lung tumors. Here we report the autopsy findings in a 97-year-old female with a history of left lung and bilateral adrenal masses. Her social history was negative for tobacco or alcohol usage. Autopsy examination revealed a 9.0 × 8.0 × 5.0-cm well-circumscribed, friable left lower lung lobe mass and extensive mediastinal lymphadenopathy. Moreover, bilateral adrenal glands were replaced by well-circumscribed and friable masses (right, 9.0 × 8.0 × 6.5 cm; left, 8.0 × 5.0 × 5.0 cm). Microscopically, the lung neoplasm was composed of epithelioid to spindle-shaped cells with marked nuclear pleomorphism and prominent nucleoli set in an inflammatory background with areas of necrosis. The neoplastic cells were intimately associated with osteoclast-type giant cells consistent with pleomorphic spindle and giant cell carcinoma. Vascular invasion, bronchopneumonia adjacent to the tumor, and alveolar congestion were also present. Two metastatic deposits were identified within the mucosal surfaces of the stomach and small intestine, showing the same histologic features seen in the lung and adrenal tumors. By immunohistochemistry, tumor cells were strongly positive for CAM5.2 and cytokeratin AE1/AE3, weakly positive for CK7 and TTF-1, and negative for WT-1, CK20, p63, S-100, and CDX-2, supporting the diagnostic interpretation. In this report, we present a case of pleomorphic carcinoma of the lung, which represents an aggressive tumor with a worse prognosis than conventional non–small cell carcinomas and a 5-year survival of only 20%.