Spindle cell carcinoma of the lung

SESSION TITLE: Lung Cancer Case Report Posters 15 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Sarcomatoid carcinoma of the lung is a rare malignancy with an incidence of 1%. Of the five histological variants, pulmonary spindle cell carcinoma variant is the rarest accounting for 0.2- 0.3% of lung cancers. (1) We present the clinical course of our patient who was diagnosed with spindle cell carcinoma and succumbed to it 9 months after diagnosis. CASE PRESENTATION: A 68 year old female presented with chronic dry cough, chest discomfort and worsening dyspnea for over 5 weeks. A computed tomogram (CT) showed a right lower lobe mass of 7.5cmx 5cm in size. Her medical history was significant for left breast cancer(adenocarcinoma).She underwent left mastectomy around 2 years ago and was on aromatase inhibitors. She had over a 100 pack years of smoking history. Bronchoscopy demonstrated an exophytic mass in the right middle lobe and enlarged subcarinal and right hilar lymph nodes. The biopsy confirmed a spindle cell carcinoma with positive cytology on subcarinal node. A PET CT scan showed contralateral metastatic disease. Patient was started on platinum based chemotherapy. She was started on chemotherapy ,immunotherapy and required bronchial stenting as well. She was found to have cerebral metastasis 8 months into treatment and chose to pursue hospice care. DISCUSSION: Spindle cell carcinoma (SpCC) is a rare type of non-small cell lung cancer with histological characteristics of epithelial and mesenchymal tumors. SpCC is strongly associated with cigarette smoking and is twice as common in males as females. Our patient had a long smoking history. SqCC may present as an endobronchial lesion or a parenchymal lesion. The former tends to present with airway obstruction and thus is usually detected sooner. Most of these neoplasms tend to already invade the mediastinal and vascular structures, resulting in early distant metastases(2). Our patient had a hilar mass and a symptomatic endobronchial lesion, but she already had spread to the other lung at the time of diagnosis.Our patient's lung mass biopsy showed proliferation of pure spindle cells without apparent epithelioid element. Immunohistochemical staining was negative for CK7,S100 and desmin. It was positive for cytokeratin AE1/AE3 and negative for SSX-C-terminus,SSX-SS18,TTF1 and p40. This suggested the diagnosis of sarcomatoid variant, which is the rarest kind of SpCC. Neuroendocrine markers were negative. Patient prognosis is mostly poor, despite surgery, radiation, and chemotherapy(3). The average postoperative survival was 5 months while the average post chemoradiotherapy survival was 2.7 months. Out patient's cancer spread to her brain despite being on chemotherapy and immunotherapy. She expired 9 months after her diagnosis. CONCLUSIONS: SpCC is a rare form of lung cancer with poor prognosis. We report this case to increase awareness about it which will help establish management protocols. Early diagnosis is the key to improving outcomes as in any kind of cancer. REFERENCE #1: 1. Dian-Jun Qi et al , Pulmonary spindle cell carcinoma with unusual morphology ,Medicine(Baltimore), 2017 June;96(24):e7129 REFERENCE #2: 2. A. Cabarcos, M.G. Dorronsoro, J.L.L. Beristain Pulmonary carcinosarcoma: a case study and review of the literature Br. J. Dis. Chest, 79 (1985), pp. 83-94 REFERENCE #3: 3. M.P. Davis, R.T. Eagen, L.H. Weiland Carcinosarcoma of the lung: Mayo Clinic experience and response to chemotherapy Mayo Clin. Proc., 59 (1984), pp. 598-603 DISCLOSURES: No relevant relationships by Megan Hughes No relevant relationships by Arunee Motes No relevant relationships by Kenneth Nugent No relevant relationships by Tushi Singh No relevant relationships by Myrian Vinan Vega Speaker/Speaker's Bureau relationship with Biodesix Please note: 2 years Added 03/29/2023 by Andres Yepes Hurtado, source=Web Response, value=Travel