Unusual primary lung neoplasms: spindle cell and undifferentiated lung carcinomas expressing only vimentin

Our plain-English summary of Unusual primary lung neoplasms: spindle cell and undifferentiated lung carcinomas expressing only vimentin, by S.P. Hammar, K.O. Hallman (Ultrastructural Pathology, 1990).

The study

• Authors: S.P. Hammar, K.O. Hallman
• Journal: Ultrastructural Pathology
• Published: 1990;14(5):407-22
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Two unusual primary carcinomas of the lung are described. One occurred in a 31-year-old man and was composed of large, undifferentiated, ovoid to polygonal cells. The other occurred in a 72-year-old man, was composed of spindle-shaped cells, and was initially diagnosed as a localized fibrous mesothelioma. The neoplastic cells of these tumors expressed only vimentin intermediate filaments and showed no other immunohistochemical features of epithelial neoplasms, although they exhibited a metastatic pattern characteristic of lung carcinomas. These two malignant neoplasms further expand the spectrum of unusual lung neoplasms, and suggest that there are pulmonary carcinomas that contain only vimentin intermediate filaments.

In plain English

The authors reported two unusual primary lung carcinomas in men who had worked at a naval shipyard. The first patient, aged 31, had a 20 pack-year smoking history and potential exposure to asbestos. The tumor was made of large undifferentiated cells, and the patient died about 9 months after diagnosis. The second patient, aged 72, had long asbestos exposure and had smoked only 2 or 3 years. A 10-cm tumor of benign-appearing spindle cells was first diagnosed as a localized fibrous mesothelioma. It recurred about 8 months later, and the patient died about 3 months after that. In both cases the tumor cells stained only for vimentin, not keratins, yet both tumors spread in the pattern of lung carcinoma. The second patient had pleural plaques and asbestos bodies in the tumor. Two lung samples contained 2900 and 7700 asbestos bodies per gram of wet lung tissue, and sections of the right lung showed focal grade I (peribronchiolar) asbestosis. The authors stated this tumor was caused by asbestos. They concluded that both tumors are probably carcinomas containing only vimentin.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (two cases)
• Who was studied: Two men: case 1, a 31-year-old naval shipyard worker with a 20 pack-year smoking history, seen in January 1987; case 2, a 72-year-old man who had worked at a naval shipyard and smoked for 2 or 3 years in his early 20s
• Exposure: Case 1: potential exposure to asbestos at a naval shipyard. Case 2: long exposure to asbestos while working at a naval shipyard. Fiber types were not named.
• Main results:
  • In case 1 the tumor immunostained only for vimentin and was negative for all the keratin and other antibodies tested; the same panel gave the same vimentin-only result in case 2
  • Case 1 died approximately 9 months after diagnosis. At autopsy the tumor extended around the lung in a pleural distribution, and the authors noted that without the hilar mass it would have resembled a diffuse mesothelioma
  • The case 2 tumor was considered most probably a localized fibrous mesothelioma, and two other consulting pathologists agreed with that diagnosis
  • The case 2 tumor recurred massively about 8 months later; the patient died approximately 3 months after diagnosis of the recurrence
  • The case 2 tumor metastasized in the pattern of a primary lung tumor (lymph nodes, adrenal glands, pericardium, myocardium, kidneys)
  • Case 2 had hyaline pleural plaques characteristic of asbestos on the diaphragmatic and pericardial surfaces, and numerous asbestos bodies in the tumor
  • In case 2, two samples of lung tissue contained 2900 and 7700 asbestos bodies per gram of wet lung tissue
  • In case 2, sections of the right lung showed focal grade I (peribronchiolar) asbestosis
  • The authors stated that the case 2 tumor was caused by asbestos, given the patient's 2-3 pack-year smoking history and 50 years without smoking
• The authors' conclusion: The authors concluded that the two tumors are probably carcinomas that contain only vimentin intermediate filaments and have dedifferentiated, while keeping the metastatic pattern of lung carcinoma
• Limitations the authors state:
  • The authors noted it is possible the tumor contained keratin that the antibodies used did not detect, though they considered this unlikely
  • The authors agreed that lack of immunostaining and electron microscopy evidence does not exclude epithelial origin, because cells may be too poorly differentiated to detect it

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Neoplasm, Spindle Cell, Carcinoma, Mesothelioma.

Related studies

• The distribution of vimentin and keratin in epithelial and nonepithelial neoplasms. A comprehensive immunohistochemical study on formalin- and alcohol-fixed tumors — N. Azumi, H. Battifora (1987)
• Immunohistochemical differentiation of sarcomatoid mesotheliomas from other spindle cell neoplasms — P.T. Cagle, L.D. Truong, et al. (1989)
• Immunohistochemical staining for vimentin and keratin in malignant mesothelioma — A. Churg (1985)
• Vimentin regulates activation of the NLRP3 inflammasome — G. dos Santos, M.R. Rogel, et al. (2015)
• Auto-antibodies to β-F1-ATPase and vimentin in malignant mesothelioma — J. Creaney, I.M. Dick, et al. (2011)
• Primary Peritoneal Low-grade Serous Carcinoma in a Patient With Lynch Syndrome: A Case Report — S. Makiuchi, H. Yoshida, et al. (2020)

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