Published online May 6, 2023. doi: 10.12998/wjcc.v11.i13.3022
Peer-review started: November 7, 2022
First decision: January 20, 2023
Revised: February 3, 2023
Accepted: March 31, 2023
Article in press: March 31, 2023
Published online: May 6, 2023
Primary dedifferentiated chondrosarcoma (DDCS) of the lung is extremely rare and has a poor prognosis, especially in patients with a history of carcinomas and related treatment. Herein, we report a case of primary DDCS of the lung in a patient with a 4-year history of breast cancer and related treatment.
A 49-year-old woman was admitted to our hospital with complaints of headache, dizziness, slurred speech, and dyskinesia in May 2021. Computed tomography (CT) examinations showed multiple nodules in the brain, vertebral body, and both lungs with multiple enlarged lymph nodes in the right hilum and mediastinum, which were considered metastases of breast cancer. No obvious mass was discovered in the right hilum. After several months of related administration, the patient's headache disappeared, and her condition improved. However, new problems of asthma, dyspnea, cough, and restricted activity appeared in late November 2021. Although the CT scan indicated that the lesions in the brain, lung, and vertebral body had shrunk or disappeared, a soft tissue density lesion appeared in her right hilum and blocked the bronchial lumen. To relieve her dyspnea, part of the mass was resected, and a stent was placed via fiberoptic bronchoscopy. Following a complete pathological examination of the tumor, it was confirmed to be a primary DDCS of the lung. The patient then received two rounds of systemic chemotherapy with a regimen of cisplatin + ifosfamide + doxorubicin hydrochloride liposome, palliative radiotherapy for the tumor in her right lung, and four cycles of systemic chemotherapy and targeted therapy with a regimen of temozolomide combined with bevacizumab successively. She was in stable condition after the completion of the systemic chemotherapy and targeted therapy but underwent rapid progression after lung radiotherapy. The CT examinations showed multiple nodules in the brain and in both lungs, and the tumor in the right hilum was increased in size.
This case revealed a rare primary DDCS of the lung with a medical history of breast cancer, meaning a worse prognosis and making it more difficult to treat.
Core Tip: Dedifferentiated chondrosarcoma (DDCS) is a rare and high-grade malignant tumor. Here, we report a case of primary DDCS of the lung with a 4-year history of breast cancer and related treatment, which is extremely rare and easily misdiagnosed. It lacks a specific clinical manifestation and a precise imaging diagnosis. Thus, an additional pathological examination is beneficial. In addition, we found that radiotherapy accelerates the progression of DDCS. Altogether, this case created a more comprehensive understanding of this tumor and will provide a reference for future diagnosis, treatment, and prognosis estimations.