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L. Ruffini
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-036 - Primary Pulmonary Large Cell Carcinoma with Syncytiotrophoblastic Aspect: Report of a Case (ID 2751)
09:30 - 09:30 | Author(s): L. Ruffini
- Abstract
Background:
To present the case of a primary large cell lung carcinoma with syncytiotrophoblastic aspect.
Methods:
A 54-year-old smoking man (60 pack/years), with no significant past medical history, presented for incidental radiological finding of a 5cm mass in the right middle lobe with partial invasion of the lower lobe (Fig.1). A PET/CT-scan showed a unique intense FDG-uptake of the pulmonary mass. A trans-thoracic fine-needle aspiration led to the diagnosis of non-small-cell lung cancer with sarcomatoid features. Preoperative cardiac and pulmonary function tests were normal. Figure 1
Results:
The patient underwent a right middle lobectomy and wedge resection of the lower lobe and radical lymphadenectomy through a posterolateral thoracotomy. The postoperative course was uneventful; the patient was discharged on the seventh postoperative day. After 52 months the patient is alive and disease-free. Macroscopically, the mass measured 5.5cm, had a greyish colour with lobulated margins. Microscopically, a poor differentiated tumor characterized by giant and medium pleomorphic cells sometimes with syncytial-trophoblastic features were observed (Fig.2a). Immunohistochemically, tumor cells were positive for beta-human-chorionic-gonadotrophin (Beta-HCG) (Fig.2b), anti-endomisium antibody (EMA), placental alkaline phosphatase (PLAP) e cytokeratin 7 (CK 7); the cells resulted negative for octamer-binding transcription factor-4 (OCT-4) (Fig.2c), spalt like transcription factor 4 (SALL4) (Fig.2d) and glypican-3. A subsequent genital examination and testicular ultrasonography excluded the presence of a primary gonadal choriocarcinoma. Beta-HCG serum levels were undetectable after surgery. Based on the above findings, a diagnosis of primary large cell lung carcinoma with syncytiotrophoblastic aspect was made. Final pathological stage was pT2aN0M0. No adjuvant therapy was proposed.Figure 1
Conclusion:
Large cell lung carcinoma with syncytiotrophoblastic aspect is an extremely rare finding. The prognosis is usually poor irrespective of the treatment; a few long-term survivors have been reported.
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P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.08-028 - Primary Large Cell Neuroendocrine Carcinoma of the Mediastinum (ID 2780)
09:30 - 09:30 | Author(s): L. Ruffini
- Abstract
Background:
to present a rare case of primary neuroendocrine carcinoma of the mediastinum treated by multimodal therapy.
Methods:
a 50-year-old man, non-smoker, with unremarkable past medical history, presented for asthenia, dyspnea and sub-sternal discomfort. A chest CT-scan showed a huge mass of 10,7x5,5x9,5cm in the anterosuperior mediastinum. The mass seems infiltrate both brachiocephalic veins, the superior vena cava, pericardium and both lungs (Fig.1a/b). PET-CT showed an intense hyperactivity of the mediastinal mass. CT-guided needle biopsy allows diagnosis of neuroendocrine carcinoma. After multisciplinary discussion, a multimodal approach was planned. The patient underwent 4 cycles of chemotherapy with cisplatin and gemcitabine. Since chest CT-scan showed a reduction of the tumor (7,4x5,6x9cm), a surgical resection was proposed. Figure 1
Results:
a median sternotomy was performed. On exploration, both lungs were marginally infiltrated. The pericardium was partially excised; the left anonymous vein was almost totally invaded by the tumor. The right anonymous vein was infiltrated at the confluence with the superior vena cava. After total caval clamping (clamping time: 27’), a partial section and reconstruction with bovine pericardium was performed (Fig.1c). The patient was discharged uneventfully on postoperative-day 9. The patient underwent 25 sessions of adjuvant radiotherapy. Currently, he’s free of disease after 30 months. Macroscopically the mass measured 9x8x3cm, looks whitish with tense-elastic consistency. Microscopically it showed clusters of small uniform cells, sometimes with cuboidal morphology, with nuclear pleomorphism and small nucleoli, arranged in trabeculae, nests and lobules and immersed in a hyaline stroma with foci of necrosis (Fig.2a). Perineural and vascular invasion were present. Immunohistochemistry showed the tumor cells were positive for chromogranin (Fig.2c), synaptophysin (Fig.2d), cytokeratins and negative for TTF1, FAP, PSA. The proliferation index Ki-67 was 10% (Fig.2b). Considering the radiological, morphological and immunophenotypic characteristics, the diagnosis was consistent with primary neuroendocrine carcinoma of the mediastinum. Figure 1
Conclusion:
mid-term survival was achieved after aggressive multimodal therapy.
