Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2021; 9(34): 10652-10658
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10652
Histology transformation-mediated pathological atypism in small-cell lung cancer within the presence of chemotherapy: A case report
Qing Ju, Ying-Tong Wu, Yong Zhang, Wen-Hui Yang, Cheng-Lei Zhao, Jian Zhang
Qing Ju, Ying-Tong Wu, Yong Zhang, Wen-Hui Yang, Jian Zhang, Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Xi'an 710000, Shaanxi Province, China
Cheng-Lei Zhao, Department of Dermatology, Southwest Hospital, Chongqing 404100, China
Author contributions: Ju Q, Zhang Y and Zhang J contributed to the conceptualization; Ju Q, Wu YT and Zhao CL collected the information; Ju Q, Zhang Y, Wu YT and Yang WH wrote the original draft; Wu YT, Zhang Y and Zhang J reviewed and edited the manuscript.
Informed consent statement: Informed written consent was obtained from the patient to publish this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jian Zhang, PhD, Doctor, Professor, Department of Pulmonary and Critical Care Medicine, Xijing Hospital, No. 127 Changle West Road, Xi'an 710000, Shaanxi Province, China.
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: April 25, 2021
Revised: May 27, 2021
Accepted: October 20, 2021
Article in press: October 20, 2021
Published online: December 6, 2021

The treatment of small-cell lung cancer (SCLC) has progressed little in recent years because of its unique biological activities and complex genomic alterations. Chemotherapy combined with radiotherapy has been widely accepted as the first-line treatment for SCLC.


Here, we present a 68-year-old male smoker who was diagnosed with SCLC of the right lung. After several cycles of concurrent chemoradiotherapy, the tumor progressed with broad metastasis to liver and bone. Histopathological examination showed an obvious transformation to adenocarcinoma, probably a partial recurrence mediated by the chemotherapy-based regimen. A mixed tumor as the primary lesion and transformation from SCLC or/and tumor stem cells may have accounted for the pathology conversion. We adjusted the treatment schedule in accord with the change in phenotype.


Although diffuse skeletal and hepatic metastases were seen on a recent computed tomography scan, the patient is alive, with intervals of progression and shrinkage of his cancer.

Keywords: Small-cell lung cancer, Adenocarcinoma, Transformation, Chemotherapy, Case report

Core Tip: In this report, we present a male patient with a diagnosis of small-cell lung cancer (SCLC) who developed metastatic adenocarcinoma, a subtype of non-SCLC, after standard chemotherapy regimens. He has survived for 90 mo since the first diagnosis, which is longer than expected.