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Case Reports
. 2025 Apr 4;87(5):3037-3042.
doi: 10.1097/MS9.0000000000003261. eCollection 2025 May.

Xeroderma pigmentosa associated with spindle cell carcinoma of lung: a case report

Bibek Shrestha  1 , Grishma Kandel  1 , Dhiraj Adhikari  1 , Sudip Bastakoti  2 , Abhinash Mishra  1
Affiliations
Case Reports

Xeroderma pigmentosa associated with spindle cell carcinoma of lung: a case report

Bibek Shrestha et al. Ann Med Surg (Lond). .

Abstract

Introduction and importance: Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective nucleotide excision repair, leading to extreme sensitivity to ultraviolet radiation, skin pigmentation changes, and a heightened risk of malignancies. Neurological symptoms, such as seizures and cognitive decline, are observed in 20% of cases. While xeroderma pigmentosa is commonly associated with skin cancers, systemic malignancies like lung carcinoma are exceedingly rare.

Case presentation: A 22-year-old male with a history of xeroderma pigmentosa presented with a six-month history of non-productive cough, hemoptysis, intermittent fever, and episodic jerky movements in his upper limb. Examination revealed hypo- and hyperpigmented macules, cachexia, cervical lymphadenopathy, and diminished air entry in the left lung. Blood tests indicated leukocytosis, elevated ESR, and abnormal electrolyte levels. Imaging confirmed a left lower lobe lung mass, and biopsy revealed spindle cell carcinoma with p53 positivity on immunohistochemistry.

Clinical discussion: Spindle cell carcinoma is a rare and aggressive subtype of non-small-cell lung cancer, comprising 0.2-0.3% of pulmonary malignancies. Its association with XP is notable, as defective DNA repair mechanisms in xeroderma pigmentosa predispose patients to malignancies driven by p53 mutations. This case emphasizes the need for vigilance for systemic malignancies in XP patients.

Conclusion: This is the first reported case of xeroderma pigmentosa associated with spindle cell carcinoma of the lung and focal seizures. It underscores the importance of early recognition and comprehensive surveillance for rare malignancies in XP patients, given their elevated cancer risk. The patient opted for palliative care and was symptomatically managed.

Keywords: DNA damage; spindle cell carcinoma; ultraviolet rays; xeroderma pigmentosum.

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Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. None.

Figures

Figure 1.
Figure 1.
Flowchart: diagnostic workup for a 22-year-old male with xeroderma pigmentosum.
Figure 2.
Figure 2.
Trucut biopsy section.
Figure 3.
Figure 3.
Ki67 (BH360).
Figure 4.
Figure 4.
P53 positive.
See this image and copyright information in PMC

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