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Case Reports
. 2017 Mar 29:21:52-55.
doi: 10.1016/j.rmcr.2017.03.019. eCollection 2017.

Small cell lung cancer transformation during immunotherapy with nivolumab: A case report

Takuma Imakita  1 , Kohei Fujita  2 , Osamu Kanai  2 , Tsuyoshi Terashima  3 , Tadashi Mio  2
Affiliations
Case Reports

Small cell lung cancer transformation during immunotherapy with nivolumab: A case report

Takuma Imakita et al. Respir Med Case Rep. .

Abstract

We report a rare case of transformation of non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC), without epidermal growth factor receptor (EGFR) gene mutation, during immunotherapy treatment with nivolumab. A 75-year-old man was referred to our hospital following the observation of a 64 mm mass in a chest computed tomography (CT) scan. A transbronchial biopsy of the mass identified the pathological presence of poorly differentiated NSCLC, with no histological signs of SCLC. No mutations were identified in the EGFR gene. A clinical diagnosis of NSCLC (cT3N3M1a, stage IV) was made following a positron emission tomography (PET)-CT scan and enhanced brain magnetic resonance imaging. Docetaxel and bevacizumab were selected as the first-line chemotherapy regimen; however, after two cycles, the patient developed a gastrointestinal perforation, and discontinuation of cytotoxic chemotherapy was recommended. Owing to gradual disease progression, immunotherapy with nivolumab was selected as the second-line regimen. During the immunotherapy, the tumor continued to progress and some subcutaneous tumors emerged. Biopsy of a subcutaneous tumor revealed SCLC, with positive immunostaining for cluster of differentiation 56, synaptophysin, and thyroid transcription factor-1. Serum tumor markers of SCLC were also elevated. Based on these results, we concluded that in this case NSCLC had transformed to SCLC during immunotherapy with nivolumab.

Keywords: Immune checkpoint inhibitor; NSCLC; Nivolumab; SCLC transformation.

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Figures

Fig. 1
Fig. 1
A: Computed tomography scan shows a mass in the lower lobe of the right lung, accompanied by small subpleural nodules and right pleural effusion. Fig. 1B–D: Initial biopsy specimens showing malignant cells with anisokaryosis and hyper chromatic nuclei (B, hematoxylin and eosin [H&E] staining × 200). Immunohistopathological analysis demonstrated weakly positive staining for thyroid transcription factor 1 (TTF-1) (C, × 200) and p63 (D, × 200), which suggested non-small cell lung cancer with unclear differentiation. Fig. 1E–G: Immunohistopathological analysis demonstrated negative staining for neuron specific enolase (NSE) (E, × 400), CD56 (F, × 400) and synaptophysin (G, × 400).
Fig. 2
Fig. 2
Second biopsy specimens showing malignant cells with diffuse proliferation of small-sized broken cells with scant cytoplasm and hyper chromatic nuclei (A, H&E staining × 200). Immunohistopathological analysis demonstrated positive staining for CD56 (B, × 200), synaptophysin (C, × 200), and TTF-1 (D, × 200), which suggested small cell lung cancer.
See this image and copyright information in PMC

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