Pulmonary Pleomorphic Carcinoma: A Case Report

Pulmonary pleomorphic carcinoma (spindle/giant cell) is a subset of sarcomatoid carcinoma. It is rare, and is seen predominantly in the sixth decade of life. The symptoms/signs and radiologic abnormalities are nonspecific. A large subpleural mass with areas of central low-attenuation is the most common finding in chest computed tomography. The pathologic diagnosis of pleomorphic carcinoma is difficult due to the heterogeneity of the tumor cells. Immunohistochemical examinations are helpful in making an appropriate diagnosis; the stains are positive for thyroid transcription factor-1, cytokeratins, and vimentin, and negative for surfactant protein-A. Pulmonary pleomorphic carcinoma has an extremely poor prognosis compared with other non-small cell lung cancers. The tumor usually relapses within 6 months after operation and median survival time after relapse is only 2.6 months. We reported the case of a 50-year-old lifelong non-smoking male with pulmonary pleomorphic carcinoma. The chest image showed a lobulated mass in the superior segment of the left lower lobe with invasion to the left upper lobe. Pneumonectomy of the left lung was performed and the diagnosis of pulmonary pleomorphic carcinoma with regional lymph node metastasis was made. The patient did not take chemotherapy after surgical resection. Brain metastasis occurred 4 months later. He died of pneumonia and septic shock 6 months after undergoing surgery.