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Eur J Cardiothorac Surg 2005;27:735
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Ismail

Masashi Gotoh*, Yasumichi Yamamoto, Cheng-Long Huang, Hiroyasu Yokomise

Second Department of Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki, Kagawa 761-0793, Japan

Received 5 January 2005; accepted 6 January 2005.

* Corresponding author. Tel.: +81 891 2191; fax: +81 87 891 2192. (E-mail: mgotoh{at}kms.ac.jp).

Key Words: Combined small cell carcinoma • Small cell carcinoma • Spindle cell carcinoma • Squamous cell carcinoma

We appreciate the interest of Ismail in our article describing combined small cell lung cancer [1]. Please find below our comments and answers to his questions.

As Ismail pointed out, small cell carcinoma is sometimes combined with a non-small cell carcinoma component and it is also known that some small cell carcinomas show histologic change after treatment [2]. However, the combination of small cell and spindle cell carcinoma is very rare because spindle cell carcinoma may present additional forms of partial mesenchymal metaplasia that are different from other types of metaplasia, as Tsubota et al. have described [3].

Concerning the primary management at the patient's local clinic, we also consider that this was not appropriate, as Ismail mentioned. Better management would seem advisable, especially for aged patients or smokers.

The lung segment designation was according to Boyden [4]. Thus S1 means the apical segment of the upper lobe and S2 means the posterior segment of the upper lobe.

In this case, the tumor appeared as a polypoid lesion and no invasion to the bronchial mucosa was revealed by bronchofiberscopy. In addition, an intraoperative frozen section of the bronchial stump revealed no invasion of carcinoma, and therefore sleeve resection was not needed. As complete resection is important for surgical oncology, care should be taken to ensure the stump is cancer-free.

As we described in our case report, chest CT revealed right hilar lymphadenopathy. Since we had initially suspected that this was lymph node metastasis, chemotherapy was performed as a primary treatment, because the American College of Chest Physicians recommends surgical resection followed by platinum-based chemotherapy even in patients with very limited-stage disease [5]. We consider that chemotherapy as a primary treatment for small cell lung cancer has gained wide acceptance.

References

  1. Gotoh M, Yamamoto Y, Huang CL, Yokomise H. A combined small cell carcinoma of the lung containing three components: small cell, spindle cell and squamous cell carcinoma. Eur J Cardiothorac Surg 2004;26:1047-1049.[Abstract/Free Full Text]
  2. Fushimi H, Kikui M, Morino H, Yamamoto S, Tateishi R, Wada A, Aozasa K, Kotoh K. Histologic changes in small cell lung carcinoma after treatment. Cancer 1996;77:278-283.[CrossRef][Medline]
  3. Tsubota YT, Kawaguchi T, Hoso T, Nishino E, Travis WD. A combined small cell and spindle cell carcinoma of the lung. Report of a unique case with immunohistochemical and ultrastructural studies. Am J Surg Pathol 1992;16:1108-1115.[CrossRef][Medline]
  4. Boyden EA. The nomenclature of the bronchopulmonary segments and their blood supply. Dis Chest 1961;39:1-6.
  5. Simon GR, Wagner H. Small cell carcinoma. Chest 2003;123:259s-271s.




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