A case of pleomorphic carcinoma with tonsillar metastasis successfully treated with S-1 following chemoradiation therapy

Abstract

Background: Pleomorphic carcinoma is considered to be a histologic subset of lung cancer in the revised classification proposed by the WHO in 1999. Although treated as non-small cell lung cancer, the effects are usually limited and the prognosis is poor. On the other hand, metastasis of the palatine tonsils is very rare and considered to be a poor prognostic factor. We experienced a case of pleomorphic carcinoma with tonsillar metastasis that was very effectively treated with S-1 after chemoradiation therapy. Case: A 63-year-old male with an abnormal chest X-ray film shadow visited a general physician and was found to have a chest tumor that was diagnosed as non-small cell lung cancer on a needle biopsy. The patient was referred to our hospital where he underwent resection of the left upper lobe. A pathological examination revealed a histological tumor diagnosis of pleomorphic carcinoma, T2N0M0, stage IB. Tumor recurrence in the left tonsil occurred during uracil-tegafur (UFT) adjuvant chemotherapy, and we administered intravenous chemotherapy consisting of carboplatin and paclitaxel with concurrent radiotherapy; however, the treatment failed to shrink the tumor. Consequently, the patient received oral S-1 therapy, and the tumor disappeared seven months later. He has exhibited progression-free survival for four years and six months on S-1 therapy. Conclusions: In the present case, S-1 therapy achieved a longterm antitumor effect on chemoradiation-refractory pleomorphic carcinoma with tonsillar metastasis. Additional cases are needed to confirm the efficacy of S-1 in patients with pleomorphic carcinoma.