A Case of Thoracic SMARCA4-deficient Undifferentiated Tumor with Early Postoperative Recurrence

DOI Web Site 13 References
  • Ito Atsushi
    Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
  • Kawaguchi Teruhisa
    Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
  • Shinoda Mari
    Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
  • Kaneda Shinji
    Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
  • Kawaguchi Koji
    Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
  • Shimamoto Akira
    Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
  • Ito Toshiyuki
    Department of Respiratory Medicine, Mie University Graduate School of Medicine
  • Fujimoto Hajime
    Department of Respiratory Medicine, Mie University Graduate School of Medicine
  • Yuasa Hiroto
    Pathology division, Mie University Hospital
  • Takao Motoshi
    Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine

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Other Title
  • 術後早期に再発をきたした胸部SMARCA4欠損未分化腫瘍の1例

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Abstract

<p>Background. Thoracic SMARCA4-deficient undifferentiated tumors are malignancies with an extremely poor prognosis, characterized by a loss of SMARCA4 expression and undifferentiated round cell or rhabdoid morphology. Case. We encountered a case of a thoracic SMARCA4-deficient undifferentiated tumor in a 63-year-old man who presented with hemoptysis and died following rapid progression. He was suspected of having left lower lobe lung cancer (cT2bN0M0: cStage IIA) by computed tomography. Therefore, we performed left lower lobectomy and lymph node dissection for the diagnosis and treatment via thoracoscopic surgery. Based on the histopathological findings, the excised tumor was diagnosed as thoracic SMARCA4-deficient undifferentiated tumor with intrapulmonary metastases [pT3 (pm1) N0M0: pStage IIB]. The patient's immediate postoperative course was good, and he was discharged on the eighth postoperative day. However, at an outpatient visit two weeks after discharge, the patient showed left pleural effusion. Thoracic drainage revealed hemorrhagic pleural effusion, and computed tomography showed bone destruction of the right second rib and swelling of the left adrenal gland, findings suggestive of metastases, although these had not been detected preoperatively. We performed diagnostic thoracoscopy and found left pleural dissemination. The patient ultimately died of respiratory failure 49 days after the initial surgery without effective therapeutic intervention for the rapidly progressing disease. Conclusion. Thoracic SMARCA4-deficient undifferentiated tumor should be considered in the differential diagnosis of tumors with undifferentiated rhabdoid morphology.</p>

Journal

  • Haigan

    Haigan 62 (5), 417-423, 2022-10-20

    The Japan Lung Cancer Society

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