Small cell carcinoma of the pleura.

ABSTRACT

We describe a patient with small cell carcinoma of the pleura who survived more than 4 years despite no response to chemotherapy. The natural history of pleural small cell carcinoma is unknown, and similar cases in the medical experience will shed light on possible treatment.

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SINCE 1989, when small cell carcinoma of the pleura was first reported in Southern Medical Journal, (1) no additional case has been described. We recently managed a case of pleural small cell carcinoma in a patient who survived more than 4 years despite lack of response to platinum-containing chemotherapy. We present the second case report of small cell carcinoma of the pleura.

CASE REPORT

A 57-year-old man with a 30 pack-year history of cigarette smoking and no previous exposure to asbestos was referred to our hospital because of right-sided chest pain. A chest x-ray film revealed right pleural-based masses in the middle and lower chest field with pleural effusion. Computed tomography (CT) of the chest showed pleural nodularities without mediastinal lymph node swelling. There was no lesion in the lung parenchyma. Fiberoptic bronchoscopy showed no endobronchial lesions, and bronchial curetting and washing were negative for malignant cells. A percutaneous tumor biopsy proved to be small cell carcinoma pathologically. Cranial magnetic resonance imaging, abdominal CT, and bone scintigraphy yielded no abnormal findings suggestive of metastases. With a tentative diagnosis of small cell carcinoma of unknown origin, systemic chemotherapy was begun with weekly CODE (cisplatin, Oncovin [vincristine], doxorubicin [Adriamycin], and etoposide). Response to therapy was evaluated as no change, but the patien t's general condition (Zubrod performance status score = 1), and the pleural lesion did not change for 21 months. Because this patient's peculiar clinical behavior differed from the ordinary response to therapy and the typical rapid disease progression, an additional percutaneous tumor biopsy was done. Results confirmed small cell carcinoma pathologically and immunohistochemically. Fifty-five months after initial therapy, the patient died of respiratory failure. Autopsy was not permitted.

DISCUSSION

In our case, lung parenchymal lesions were not found on imaging studies or fiberoptic bronchoscopy. As with the first case, (1) the immunohistochemical staining (specifically the reactive neuron-specific enolase and chromogranin A) leaves little doubt about the histologic diagnosis. We are left with the conclusion that this is the second reported case of pleural small cell carcinoma. Our patient survived more than 4 years without declining performance status despite lack of response to platinum-containing chemotherapy, which was a peculiar clinical behavior differing from the ordinary course of small cell carcinoma of the lung. We reported this case because the natural history of pleural small cell carcinoma is unknown and the accumulation of similar cases in the medical experience will shed light on a possible treatment.

References

(1.) Bouvier DP, Bell B: Small cell carcinoma of the pleura. South Med J 1989; 82:1437-1438

RELATED ARTICLE: KEY POINTS

* We present the second case report of a patient with small cell carcinoma of the pleura.

* Our patient survived more than 4 years despite no response to chemotherapy.

* The natural history of pleural small cell carcinoma is unknown, and similar cases in the medical experience will shed light on a possible treatment.

From the Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-City, Ibaraki, Japan. Reprint requests to Hiroaki Satoh, MD, Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-City, Ibaraki, 305-8575, Japan.