Pulmonary spindle cell carcinoma: case report and literature review

Abstract

Spindle cell carcinoma is a rare and malignant variety of squamous cell carcinoma. It is a tumor that is constituted by a double cell proliferation: a carcinomatous sarcomatous epithelial cells of spindle cells and another sarcomatous of spindle cells. It can affect any part of the body; however, it is more commonly found in upper airway and digestive tract. It affects men more frequently between the sixth and seventh decade of life. It has an aggressive behavior with a tendency of recurrence. Alcohol and tobacco have been identified as the most important risk factors. The histopathological diagnosis is complicated and it is often necessary to resort to immunohistochemical techniques and the use of the electron microscope. Given the infrequent strain, it is considered important to publish the information collected from a case in our environment to compare it with what is currently described in the literature. Pulmonary and Respiratory Medicine International Journal Submit your Article | www.ologypress.com/submit-article Ology Press Citation: Basilio AEH, Zuñiga COC, Rocha FIH, et al. Pulmonary spindle cell carcinoma: case report and literature review. Pulm Resp Med Int J. (2019);2(1):1-3. DOI: 10.30881/prmij.00009 2 of 18,340 uL, with neutrophils of 17,550 uL (95.7%), lymphocytes 460 uL (2.5%) monocytes 290 uL ( 1.6%), eosinophils of 0%, and basophils of 40 uL (0.2%). This is why third-generation cephalosporin and macrolide are initiated for suspected community-acquired pneumonia with pleural effusion. The following approach was to perform a contrast computed tomography of the thorax, which reported a tumor with central necrosis in the right hemithorax of 3.5 inches x 4.3 inches, infiltrating the right pulmonary bronchus from its origin in the main carina, with peripheral enhancement, practically collapsing the right hemithorax in its entirety, with left hemithorax without evident alterations, and mediastinum with retraction towards affected hemithorax as well as infiltration to fat, presence of adenopathies reporting 1.1 inches as the largest diameter located sub-carinal. The esophagus showed a loss of fat separation interface in the middle third, which is why it is considered infiltration of the same. Bone tissues showed only degenerative changes and soft tissues with hypotrophy. The department of diagnostic radiology suggested the diagnosis of bronchogenic cancer, possibly of large cells, thus requiring histopathological confirmation. Macrolide was suspended and clindamycin was initiated for probable post obstructive pneumonia. During his hospital stay prior to his bronchoscopy, the patient was found to have a transcutaneous oxygen measurement of 89% without supplementary oxygen, which improved with the administration of supplementary oxygen by nasal tips at 0.5 L/min. Continuing with the same symptomatology, the patient was stable. A bronchoscopy was performed with diagnostic cryobiopsy, showing extrinsic compression of the middle third of the trachea, 100% obstruction of the right main bronchus with extension to the main carina and permeabilization of the intermediate bronchus, persisting with obstruction of the lobar bronchi and partial recanalization of the basal trunk. Therefore, bronchial lavage was sent to culture and cytology, as well as cytology and immunohistochemistry biopsy. Crops reported negative and the pathology reports indicated Fusocellular malignant neoplasm compatible with spindle cell carcinoma with focally positive Cytokeratin AE1 / AE3, Negative TTF and Negative P63 (Figures 2-4). Figure 1 A) Coronal CT-Scan of the chest, mediastinal window B) Axial Slide of a CT-CT-Scan of the chest, mediastinal window C) Axial Slide of a CT-CTScan of the chest, Lung Window. Figure 2 Negative Immunohistochemical expression of P63. Figure 3 Negative Immunohistochemical expression of TTF-1. Figure 4 Positive Cytokeratin AE1/AE3.