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Madhabananda Kar



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    EP1.09 - Pathology (ID 199)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Pathology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.09-15 - Unusual Malignancies of Lung-Experience from a Tertiary Care Centre of Eastern India (Now Available) (ID 184)

      08:00 - 18:00  |  Author(s): Madhabananda Kar

      • Abstract
      • Slides

      Background

      Carcinoma lung accounts for 12.3% of all malignancies globally and is the leading cause of deaths due to malignancies.Pathologically,among various types of lung carcinomas;adenocarcinoma,squamous cell carcinoma,small cell and large cell carcinoma are the common varieties encountered.However there are certain uncommon variants of malignancies arising in lung which require distinct diagnostic and management approach and hence pose a challenge to the oncologist.Hereby we present our experience with some of these unusual pathologic variants of lung malignancies with relevant literature review.

      Method

      A retrospective analysis was done from the hospital records of patients visiting at a tertiary cancer hospital of eastern India between June 2013 to December 2018.All patients with biopsy or cell block proven diagnosis of lung malignancies were included in the study.Common pathological types of lung carcinoma such as adenocarcinoma,squamous cell carcinoma and small cell carcinoma were excluded from the study.

      Result

      Among a total of 216 lung malignancies presented during this time period, six patients presented with unusual pathological variants such as: synovial sarcoma,lymphoma(diffuse large B cell lymphoma),neuroendocrine carcinoma,mucoepidermoid carcinoma,basaloid squamous cell carcinoma and adenosquamous carcinoma(one case from each pathological type).All six patients in the study were male with age range 31-74 years(median-49 years).Out of these six cases,laterality was evenly distributed i.e three cases had malignancies on left lung whereas in other three cases right lung was involved. Three patients had distant metastasis during presentation(synovial sarcoma, adenosquamous carcinoma and DLBCL) whereas other three patients were nonmetastatic at presentation.The presentation,histopathological diagnosis and immunohistochemistry,treatment received and followup of the patients are briefly summerised in the table.Among these six patients,one has died(adenosquamous carcinoma),one has lost followup and four patients are on followup(range-2-24 months).

      Table showing clinicopathological and treatment details of patients
      sl no sex Age(yrs) laterality histopathology IHC stage at presentation mets treatment f/u
      1 m 37 left

      synovial sarcoma

      Bcl-2,CD99+, CD34-,CK7- III no 3X(adriamycin+ifosfamide)--progressive disease lost to f/u
      2 m 67 left

      adenosquamous carcinoma

      IV Bone(clavicle,rib) 6X(paclitaxel+carboplatin)--zolendronate,tab gefitinib Death after 8 mnth f/u
      3 m 48 right neuroendocrine carcinoma Synaptophysin, Chromogranin A+ve,TTF-1 weakly +ve III no 3XEP--excision of mediastinal mass with rt upper lobectomy 24 mnth
      4 m 50 right DLBCL CD45,CD20,BCl2+ IV adrenal gland 6XRCHOP--2XRituximab+prednisolone 2 mnth
      5 m 74 right basaloid squamous cell carcinoma panCK,p40,p63+,Mib-1>70% IIIA no 3X(gemcit+carbo)--partial response--CCRT 15 mnth
      6 m 31 left mucoepidermoid carcinoma p63,CK5/6/7+, Her2neu+ IIIA no thoracotomy & resection--4XTCH--maintenance TrastuzumabX14 2 mnth

      Conclusion

      Unusual malignancies of lung pose a diagnostic and therapeutic challenge to the oncologist in clinical practise owing to paucity of relevant data and insufficient studies.However they are treated according to the specific histopathologic subtype and stage of presentation.More studies are needed to be conducted regarding this subgroup of malignancies and their management

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