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Pulmonary Pleomorphic Carcinoma Mimicking Primary Sarcoma of the Neck: A Case Report and Literature Review

Authors Ogawa D, Arahata M, Kuriyama M, Shinagawa S, Tomizawa G, Shimizu Y

Received 11 December 2020

Accepted for publication 5 February 2021

Published 23 February 2021 Volume 2021:16 Pages 325—333


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Nandu Goswami

Daishi Ogawa,1,2 Masahisa Arahata,2 Masato Kuriyama,3 Shunji Shinagawa,3 Gakuto Tomizawa,4 Yukihiro Shimizu3

1Nanto Community Medical Support Unit, Toyama University Hospital, Toyama, Toyama, Japan; 2Department of General Medicine, Nanto Municipal Hospital, Toyama, Toyama, Japan; 3Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan; 4Department of Radiology, Nanto Municipal Hospital, Nanto, Toyama, Japan

Correspondence: Masahisa Arahata
Department of General Medicine, Nanto Municipal Hospital, 938 Inami, Nanto, Toyama, 932-0211, Japan
Tel +81-763-82-1475
Fax +81-763-82-1853

Abstract: We describe our challenge in diagnosing an unusual and rapidly progressing case of pulmonary pleomorphic carcinoma (PPC)—a rare, poorly differentiated, or undifferentiated non-small-cell carcinoma that can metastasize locally or distantly and has a poor prognosis. Our patient was an elderly man with a one-month history of abdominal pain, anorexia, and weight loss, diagnosed with atrophic gastritis via endoscopy, and treated medically without improvement. A week later, this patient developed pain in the head, neck, and shoulder area, and further examination revealed a thickening of his left neck and shoulder, with no palpable lymph nodes. Computed tomography (CT) of the neck, chest, and abdomen led us to believe that we might be dealing with primary sarcoma of the neck since no lung mass was evident. Further investigation could not be performed because the patient’s status deteriorated rapidly. An autopsy revealed that soft tissue in the left neck and the mesentery was invaded by poorly differentiated polymorphic malignant cells, which were also seen in the lung lesion. Immunohistochemically, these malignant cells were all positive for AE1/AE3, CAM5.2, TTF-1, Napsin-A, and Vimentin. The cells were also positive for programmed death-ligand 1 staining with a low level of tumor proportion score (over 1%). The final diagnosis was PPC with metastases to soft tissues in the left neck and the mesentery. A review of previous case reports of PPC revealed that soft tissue is an uncommon site for metastasis, and that our CT findings were rather unusual. We hereby present our case and review of published case reports, with the hope that an awareness of the heterogeneous features of PPC could prompt timely biopsy and histological diagnosis.

Keywords: pleomorphic carcinoma of the lung, non-small-cell lung cancer, metastases to soft tissues, mesentery, poor prognosis

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