Long-term survival in a case of pleomorphic carcinoma with a brain metastasis

Abstract

Pleomorphic carcinoma (PC) is a rare malignant lung tumor with a poorer prognosis compared to other histological types of non-small cell lung cancer. However, several recent immunohistochemical studies revealed that a low MIB-1 index is a good prognostic marker in patients with PC. We report the case of a patient with PC and a single brain metastasis that achieved long-term recurrence-free survival following treatment with combined modality therapy. In this case, the MIB-1 index was reduced by gemcitabine-based chemotherapy, which may have led to long-term disease-free survival. The MIB-1 index may be a useful biomarker for the response to chemotherapy.

Keywords: Adjuvant/neoadjuvant therapy; Lung cancer surgery; Metastases.

Fig. 1

a Brain CT showing a 50 × 50 mm mass lesion in the right frontal lobe. b Chest X-ray showing a nodular mass shadow with a cavity in the right-middle lung field. c, d Chest CT showing a 70 × 68 mm mass with a cavity in the right lower lobe (c) and a reduced nodular shadow (62 × 50mm) after 6 courses of chemotherapy (d).

Fig. 2

Postoperative specimen of the lung showing a 64 × 48 mm tumor in the right lower lobe macroscopically (a) and large, spindle-shaped atypical cells proliferating sarcomatously into most of the tumor portions microscopically (b). The MIB-1 index in the specimen obtained by CT-guided percutaneous lung biopsy before preoperative chemotherapy is high at 60% (c), but low at 10% in the specimen of the resected tumor (d).