title: Unexpectedly long intravenous and intracardiac extension of a small-sized pulmonary pleomorphic carcinoma.
abstract: Pleomorphic carcinoma of the lung is one of the uncommon histological types of lung cancers, which shows an aggressive behavior. Intravenous extension (not metastasis or direct invasion) of the tumor into the heart is a rare complication of lung cancers. We present a case of a 64-year-old man, who was admitted to hospital due to severe dyspnea. Chest CT scan revealed a 2-cm nodule in the upper lobe of the right lung. Echocardiography demonstrated a giant mass in the left atrium. Because of a considerable distance between the lung nodule and heart, the relation of these two lesions was unclear. He died four days after the admission. At autopsy, the lung nodule was pleomorphic carcinoma composed of spindle and giant cells, which invaded the pulmonary vein and extended intravenously to the left atrium. The intravenous component of the tumor measured approximately ten cm in length. At the tip of the extension, an 8 cm × 5 cm × 3 cm mass was formed in the left atrium, which obstructed the mitral valve. This case highlights a possibility that even a small-sized, peripherally located pleomorphic carcinoma of the lung could extend for an unexpectedly long distance to the heart, causing cardiac complications.
authors.affiliation: 1 Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan ; 2 Department of Internal Medicine, Ube Industries, Ltd. Central Hospital, Ube, Japan ; 3 Division of Surgical Pathology, Yamaguchi University Hospital, Ube, Japan ; 4 Department of Basic Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Ishii
authors.affiliation: 1 Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan ; 2 Department of Internal Medicine, Ube Industries, Ltd. Central Hospital, Ube, Japan ; 3 Division of Surgical Pathology, Yamaguchi University Hospital, Ube, Japan ; 4 Department of Basic Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Tokuhiro
authors.initials: T
authors.lastname: Kimura
authors.affiliation: 1 Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan ; 2 Department of Internal Medicine, Ube Industries, Ltd. Central Hospital, Ube, Japan ; 3 Division of Surgical Pathology, Yamaguchi University Hospital, Ube, Japan ; 4 Department of Basic Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Koshiro
authors.initials: K
authors.lastname: Moritani
authors.affiliation: 1 Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan ; 2 Department of Internal Medicine, Ube Industries, Ltd. Central Hospital, Ube, Japan ; 3 Division of Surgical Pathology, Yamaguchi University Hospital, Ube, Japan ; 4 Department of Basic Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Dan
authors.initials: D
authors.lastname: Cui
authors.affiliation: 1 Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan ; 2 Department of Internal Medicine, Ube Industries, Ltd. Central Hospital, Ube, Japan ; 3 Division of Surgical Pathology, Yamaguchi University Hospital, Ube, Japan ; 4 Department of Basic Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: 1 Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan ; 2 Department of Internal Medicine, Ube Industries, Ltd. Central Hospital, Ube, Japan ; 3 Division of Surgical Pathology, Yamaguchi University Hospital, Ube, Japan ; 4 Department of Basic Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kawano
authors.affiliation: 1 Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan ; 2 Department of Internal Medicine, Ube Industries, Ltd. Central Hospital, Ube, Japan ; 3 Division of Surgical Pathology, Yamaguchi University Hospital, Ube, Japan ; 4 Department of Basic Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Ikeda
keywords: Lung cancer; intracardiac extension; mitral valve; pleomorphic carcinoma; secondary cardiac tumor