An Autopsy Case of Rapidly Progressing Spindle Cell Carcinoma of the Lung Accompanied with Intratumor Hemorrhage
Challenging differential diagnosis, Unusual setting of medical care, Unexpected drug reaction , Rare disease
Jun-ichiro Kida, Nobuhiro Kanaji, Sosuke Kishi, Katsumi Imaida, Shuji Bandoh
(Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan)
Am J Case Rep 2015; 16:805-810
Spindle cell carcinoma (SPCC) of the lung is a subset of sarcomatoid carcinoma. Its clinical features are unclear because of its rarity. Here, we report an autopsy case of SPCC and review CT findings and chemotherapeutic regimens based on previous reports of this disease. To our knowledge, this is the first reported case of pemetrexed used to treat SPCC.
CASE REPORT: A 74-year-old Japanese male presented with dyspnea and contrast-enhanced computed tomography (CT) showed abundant left pleural effusion and a mass in lower lobe of the left lung. By the tumor biopsy, he was diagnosed for SPCC of the lung, cT3N0M1a, stage IV. The tumor was resistant to chemotherapy with carboplatin and pemetrexed, and rapidly progressed. Autopsy revealed abundant hemorrhage within the tumor, which apparently reflects a low-density area in CT.
CONCLUSIONS: Present case and the accumulation of cases indicate that low-density areas in CT and rapid tumor progression may be common SPCC findings.
Keywords: Autopsy, Aged, Carcinoma - diagnosis, Fatal Outcome, Hemorrhage - etiology, Humans, Lung Neoplasms - diagnosis, Male, Neoplasm Staging, Tomography, X-Ray Computed