Spontaneous Regression Of Recurrent Pulmonary Large Cell Neuroendocrine Carcinoma With Alteration Of Pd-l1 Expression After Surgical Resection: A Case Report
Hong, G., Chung, C., Park, D., Lee, S. I., Lee, J. E., & Kang, D. H. (2024). Spontaneous regression of recurrent pulmonary large cell neuroendocrine carcinoma with alteration of PD-L1 expression after surgical resection: A case report. Thoracic cancer, 15(3), 266–270. https://doi.org/10.1111/1759-7714.15184
View Original Source →Abstract
Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive subtype of non-small cell lung cancer with a poor prognosis. Spontaneous regression, that is, partial or complete disappearance of a malignancy without medical intervention, is extremely rare in LCNEC. Herein, we present a case of spontaneous complete regression in a 71-year-old male patient with recurrent LCNEC after surgical resection. The patient was diagnosed with stage IB LCNEC and underwent surgical resection. At 1-year follow-up, chest computed tomography revealed a recurrent lesion next to the stump site and enlargement of lymph nodes 4R and 7; recurrent LCNEC was confirmed. The patient declined chemoradiation therapy. One year after recurrence, the patient experienced severe multifocal necrotizing pneumonia and was treated with antibiotics, resulting in a gradual decrease in the size of the recurrent lesion. Five years after the initial diagnosis, positron emission tomography/computed tomography revealed no hypermetabolic lesions, indicating the spontaneous complete regression of LCNEC.
Case Details
Disease Location
Lung
Personal Characteristics
71-year-old man. History of 30 pack-years of smoking
Clinical Characteristics
Admitted with a lung mass detected on chest computed tomography (CT). Biopsy revealed an undetermined malignant tumor. Right middle lobe (rml) lobectomy was performed. Pathological examination of the excised specimen revealed a neuroendocrine carcinoma. All the cells showed positive staining for CD56 and programmed death-ligand 1 (pd-l1) >90%. Follow-up chest CT and PET-CT 1 year after surgery showed a new soft-tissue lesion next to the stump site and enlargement of lymph nodes 7 and 4r. Endobronchial ultrasound-guided transbronchial needle aspiration revealed metastatic neuroendocrine carcinoma in both lymph nodes. One year after the diagnosis of recurrence, he visited the emergency room with a fever, cough, and sputum. Multiple nodules with central necrosis in the left upper, left lower, and right lower lobes were observed on chest CT, suggesting multifocal necrotizing pneumonia. He was treated with intravenous antibiotics for 3 weeks, and percutaneous catheter drainage and urokinase instillation were performed for left loculated parapneumonic effusion.
Remission Characteristics
Follow-up chest CT showed improvement in the pneumonia and a gradual decrease in the recurrent lesion, which was not visible after 1 year.
Treatment & Mechanisms
Proposed Remission Mechanisms
Severe inflammation associated with necrotizing pneumonia may have triggered a systemic immune response that was involved in spontaneous regression.
Clinical Treatment
Biopsy, antibiotics