This report details a rare case of solid-variant primary pulmonary adenoid cystic carcinoma (PACC) with pleural metastasis and malignant effusion in a 65-year-old man. The case emphasizes the importance of accurate immunohistochemical diagnosis and explores the potential of combination immunotherapy in advanced PACC.
Background
Pulmonary adenoid cystic carcinoma (PACC) is a rare malignancy that constitutes a small fraction of lung neoplasms, often leading to diagnostic challenges due to its overlapping immunophenotypic features with other tumors. The solid variant of PACC, particularly with pleural metastasis, is exceptionally uncommon and associated with more aggressive clinical behavior. Understanding its presentation and treatment options is crucial for improving patient outcomes.
Data Highlights
No numerical data or trial data available in the article.
Key Findings
The patient was initially misdiagnosed with squamous cell carcinoma due to overlapping immunophenotypic features.
Diagnosis was revised to solid-variant PACC after comprehensive immunohistochemical analysis.
The patient presented with advanced stage IV disease, characterized by pleural metastasis and malignant pleural effusion.
Combination therapy with tislelizumab and chemotherapy resulted in a partial response and symptomatic improvement.
No grade ≥3 treatment-related adverse events were reported during the treatment course.
Clinical Implications
This case underscores the necessity of incorporating myoepithelial markers in the diagnostic workup of lung tumors to avoid misdiagnosis. Clinicians should consider combination immunotherapy as a potential treatment strategy for advanced PACC, given the observed response in this case.
Conclusion
The report highlights the diagnostic complexities associated with solid-variant PACC and suggests that combination therapies may offer a viable treatment option in advanced cases. Further studies are warranted to establish standardized treatment protocols.
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