Whole-Process Treatment of Combined Small Cell Lung Cancer Initially Diagnosed as "Lung Squamous Cell Carcinoma": A Case Report and Review of the Literature

Abstract

The rarity and complexity of histology lead to the low diagnosis rate and high misdiagnosis rate of combined small cell lung cancer (C-SCLC). Nowadays, C-SCLC has no commonly recommended therapeutic regimen, mainly conforming to SCLC treatment. Here, we report a patient initially diagnosed as IIIA "lung squamous cell carcinoma" by a small specimen. Radical resection was achieved after neoadjuvant immunochemotherapy, and the final surgical pathology was C-SCLC containing three different histological components. Moreover, in the literature review, we explored the therapeutic effect of neoadjuvant immunotherapy in C-SCLC, expounded the therapeutic conflicts among heterogeneous components, and analyzed the pathology complexity at the tissue, cell, and molecule levels in-depth, including possible genetic characteristics, origin, and evolution by next-generation sequencing (NGS).

Keywords: NGS; c-SCLC; case report; heterogeneity; neoadjuvant immunotherapy.