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Amr Ismail

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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.CR-03 - Pulmonary Spindle Cell Neoplasm - Neoadjuvant Treatment and Response (ID 11756)

      12:00 - 13:30  |  Author(s): Amr Ismail

      • Abstract
      • Slides


      Sarcomatoid carcinoma (SC) of the lung comprises a small subset of non-small cell lung cancer (NSCLC) accounting for no more than 3% of all lung tumors.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Section not applicable

      4c3880bb027f159e801041b1021e88e8 Result

      A 66-year-old Caucasian man was seen in the ED for the complaints of shortness of breath, productive cough, and fever. He had a 70 pounds unintentional weight loss over 5 months and generalized weakness. His medical history included COPD, HTN, HLD, and tobacco abuse (108 pack years of smoking). He denied alcohol or illicit drug use. He was treated with antibiotics for COPD exacerbation with symptomatic improvement; However, he had a chest X-ray finding notable for an 8 cm right upper lung mass.

      Chest CT showed 6.3 x 7.9 x 8 cm RUL pleural-based mass with areas of low density changes and irregular opacity measuring 3.7 x 6.5 x 7.5 cm abutting the pleura in the right lower lobe. A right hilar node was also seen measuring up to 2.3 x 2.9 cm in size. Abdomen/pelvis CT and MRI brain showed no gross evidence of metastatic disease. The bone scan was negative for blastic or lytic bone disease. He had a CT guided biopsy which identified a spindle cell neoplasm. Histopathology confirmed spindle cells with markedly atypical nuclei amid a hyalinized background, with areas of necrosis. Immunoperoxidase stains were positive for CKAE1/AE3 and vimentin with diffuse staining. CK7 was focally positive in very few cells, as were Ber-EP4 and calretinin. PAX8 was negative.

      Transthoracic echocardiogram showed grade I diastolic dysfunction with preserved ejection fraction. Pulmonary function testing showed severe obstructive pattern consistent with severe COPD, making him a poor surgical candidate. The final decision was made to start the patient on concurrent chemoradiation.

      Initial chemotherapy regimen was Ifosfamide 1200 mg/m2 along with Mesna 240 mg/m2 to be given for a total of 15 doses. He was also planned to have Intensity-modulated radiation therapy of 3000 Centigray over 15 fractions to the lung. He finished 6 cycles of chemotherapy. He tolerated his regimen well with only mild neutropenia.

      Repeat CT chest showed interval decrease of the right upper lobe mass (now 4.5 x 1.7 cm instead of 7.9 x 4.7 cm) and a hilar lymph node that measured 1.3 x 1.3 cm (previously measuring 2.3 x 2.9 cm).

      8eea62084ca7e541d918e823422bd82e Conclusion

      We present a patient that received concurrent chemoradiotherapy with initial response on CT imaging. This can provide an acceptable alternative to patients presenting with non-resectable tumors.


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