Image in Medicine: Squamous Cell Granulomas in Completely Regressed Stage IIIB Lung Cancer after Chemoradiation Therapy

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Jie Song MD
Department of Pathology, University of Chicago Medical Center, Chicago, Illinois

Address:

Aliya N. Husain MD
Department of Pathology, University of Chicago Medical Center, Chicago, Illinois

Address:

Citation: J. Song & A. Husain : Image in Medicine: Squamous Cell Granulomas in Completely Regressed Stage IIIB Lung Cancer after Chemoradiation Therapy. The Internet Journal of Pulmonary Medicine. 2009 Volume 11 Number 2

Keywords: Squamous cell carcinoma | lung cancer | chemoradiation therapy | squamous cell granuloma

Abstract

A stage IIIB squamous cell carcinoma of the lung was treated with neoadjuvant chemoradiation therapy before pneumonectomy. The postsurgical specimen showed complete pathologic response with no viable tumor identified. However, extensive squamous cell granulomas were present in the previous tumor bed. Squamous cell granulomas can cause diagnostic difficulty, and have only been previously described in treated head and neck squamous carcinomas in the literature.

Case Report

A 52-year-old man presented with cough. CT scan revealed a right bronchial lesion, diagnosed as squamous cell carcinoma on biopsy. Exploratory thoracotomy revealed invasion into the pulmonary vein and a positive level 7 lymph node, leading to stage IIIB (T4, N2, M0). The patient underwent chemoradiation therapy with cisplatin, etoposide and 60 Gy of mediastinal radiation, followed by right pneumonectomy. Post-operative pathology revealed complete response (ypT0, N0) without residual tumor. However, numerous squamous cell granulomas were seen in the previous tumor bed, some within arterial walls suggesting previous lymphatic invasion (Fig. 1, 100x), and some within hilar lymph nodes with prominent asteroid bodies (Fig. 2, 100x; inset, 400x).

Figure 1: The wall of an artery with squamous cell granulomas

Figure 2: Squamous cell granulomas in hilar lymph node, with prominent asteroid body

Discussion

This case demonstrates the efficacy of chemoradiation therapy for high stage, metastatic squamous cell carcinoma of the lung. Complete pathological response after chemoradiation therapy has been documented in this type of tumors.¹Extensive squamous cell granulomas can cause diagnostic difficulty, and have only been described in the literature in treated head and neck squamous cell carcinomas.²

Correspondence to

Aliya N Husain M.D.
Department of Pathology
University of Chicago Medical Center
5841 S. Maryland Avenue, MC 6101
Chicago, IL 60637
Phone: 773.834.8397
Fax: 773.834.7644
Email: Aliya.Husain@uchospitals.edu

References

1. Stupp R, Mayer M, Kann R, Weder W, Zouhair A, Betticher DC, et al. Neoadjuvant chemotherapy and radiotherapy followed by surgery in selected patients with stage IIIB non-small-cell lung cancer: a multicentre phase II trial. Lancet Oncol 2009; 10(8): 785-93 (s)

2. Westra WH, Forastiere AA, Eisele DW, Lee DJ. Squamous cell granulomas of the neck: histologic regression of metastatic squamous cell carcinoma following chemotherapy and/or radiotherapy. Head Neck 1998; 20(6): 515-21 (s)

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