[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-444326-105":59,"doc-detail-444326-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","hemothorax-as-the-initial-manifestation-of-kras-g12d-positive-pulmonary-pleomorphic-carcinoma-a-case-report","Hemothorax as the Initial Manifestation of KRAS G12D Positive Pulmonary Pleomorphic Carcinoma - A Case Report","","Pulmonary pleomorphic carcinoma (PPC) is an uncommon lung cancer type with rapid progression and poor prognosis. Hemothorax as the initial clinical presentation of PPC is exceptionally rare and had not been previously reported. This case describes a KRAS G12D-mutated PPC that penetrated the visceral pleura, causing rapid tumor growth and uncontrolled hemothorax, likely driven by KRAS G12D–associated oncologic properties. Timely recognition, complete macroscopic resection with definitive hemostasis, and prompt postoperative therapy are essential for improved outcomes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hemothorax-as-the-initial-manifestation-of-kras-g12d-positive-pulmonary-pleomorphic-carcinoma-a-case-report/444326/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hemothorax-as-the-initial-manifestation-of-kras-g12d-positive-pulmonary-pleomorphic-carcinoma-a-case-report/444326.png","ImageObject",300,407,{"name":92,"@type":93},"Stanley","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is hemothorax an important presentation in pulmonary pleomorphic carcinoma (PPC)?","Question",{"text":113,"@type":114},"Hemothorax as an initial presentation of PPC is exceptionally rare and led to diagnosis in this case. The report emphasizes its association with aggressive disease behavior and poor outcomes.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What role does the KRAS G12D mutation play in this case?",{"text":118,"@type":114},"The tumor carried a KRAS G12D mutation and was linked to rapid growth and recurrence of massive hemothorax. The authors suggest KRAS G12D–related oncologic properties contributed to abrupt onset and recurrence.",{"name":120,"@type":111,"acceptedAnswer":121},"How did clinicians attempt to manage the bleeding, and what was the outcome?",{"text":122,"@type":114},"Video-assisted thoracoscopic surgery was performed, but only palliative (R2) resection could be achieved. After postoperative day 9, a second massive hemothorax occurred, and although hematoma evacuation and pleurodeses were attempted, bleeding was not controlled and the patient died 30 days after symptom onset.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},444326,1790790422,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":39,"preview_page_count":4},2336477405376,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Respirology Case Reports  \nCASE REPORT  OPEN ACCESS   \nHemothorax as the Initial Manifestation ofKRAS G12D Positive Pulmonary Pleomorphic Carcinoma:  \nA Case Report  \nTakuma Ikeda1  | Hirotaka Matsumoto1 | Shigenari Iwagaki1 | Ryo Ogawa1 | Yushi Shimamura1  | Emiko Saito1 | Takehisa Fukada2  | Hiroaki Sakai2   \n1Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki-shi, Hyogo, Japan | 2Department of Thoracic  \nSurgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki-shi, Hyogo, Japan Correspondence: Takuma Ikeda ([sfavatakuma@gmail.com](sfavatakuma@gmail.com))  \nReceived: 1 November 2025 | Revised: 1 December 2025 | Accepted: 14 December 2025  \nAssociate Editor: Michael Hsin  \nKeywords: hemothorax | KRAS G12D | non-small-cell lung cancer | pulmonary pleomorphic carcinoma  \nABSTRACT  \nPulmonary pleomorphic carcinoma (PPC) is a rare subtype of lung cancer that is characterised by rapid progression and poor prognosis. Hemothorax as the initial clinical presentation of PPC is exceptionally rare and, to the best of our knowledge, has not been previously reported. Here, we report a rare case of a KRAS G12D-mutated PPC penetrating the visceral pleura, leading to rapid tumour growth and uncontrolled hemothorax. In addition to the high proliferative and invasive potential of the tumour, the oncological properties associated with the KRAS G12D mutation likely precipitated both the abrupt onset and recurrence of massive hemothorax. Early recognition, complete macroscopic resection to achieve definitive haemostasis, and prompt initiation of postoperative therapy are essential to improve clinical outcomes.  \n1 | Introduction  \nPulmonary pleomorphic carcinoma (PPC) is a rare sarcomatoid carcinoma, accounting for only 0.1%–0.3% of all lung cancers. It is defined histologically as a poorly differentiated carcinoma containing at least 10% spindle or giant cells. PPC progresses rapidly, and even in the early stages, it frequently invades the pleura and vasculature, resulting in a high risk of postoperative recurrence. In advanced stages, the prognosis is worse, with a reported median survival time of 2 months anda 5-year overall survival of 2.2%[1]. Cavitation and pleural invasion are recognised as independent risk factors for mortality [2] . Hemothorax as the presenting feature of PPC is extraordinarily rare and has not, to our knowledge, been previously  \nreported. Herein, we report the first case of massive hemothorax caused by a KRAS G12D-mutated PPC.  \n2 | Case Report  \nA 56-year-old woman, a never-smoker with no notable medical history, presented with a three-day history of hemoptysis. Chest computed tomography (CT) revealed an infiltrative opacity surrounded by ground-glass attenuation in the left lower lobe (Figure 1A) . Community-acquired pneumonia was suspected, and antibiotics were administered. Three days later, CT showed progression of the lesion and a small left pleural effusion (Figure 1B) . One week later, the pleural effusion  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.  \nRespirology Case Reports, 2026; 14:e70454 1 of 3  \n[https://doi.org/10.1002/rcr2.70454](https://doi.org/10.1002/rcr2.70454)  \nFIGURE 1 | Computed tomography (CT) image. Initial CT (A) shows consolidation in the left lower lobe with surrounding ground-glass opacity. Three days later, follow-up CT (B) demonstrates an irregularly marginated nodule within the consolidation and a newly appeared small left pleural effusion. One week later, CT (C) shows marked enlargement of the irregular mass along with a large amount of high-attenuation pleural effusion, consistent with hemothorax.  \nexpanded abruptly, an","cbCaifHZLII3BP2m","https://ap.wps.com/l/cbCaifHZLII3BP2m","pdf",3503485,"English","# Abstract\n# Introduction\n# Case Report\n# Discussion","[{\"question\":\"Why is hemothorax an important presentation in pulmonary pleomorphic carcinoma (PPC)?\",\"answer\":\"Hemothorax as an initial presentation of PPC is exceptionally rare and led to diagnosis in this case. The report emphasizes its association with aggressive disease behavior and poor outcomes.\"},{\"question\":\"What role does the KRAS G12D mutation play in this case?\",\"answer\":\"The tumor carried a KRAS G12D mutation and was linked to rapid growth and recurrence of massive hemothorax. The authors suggest KRAS G12D–related oncologic properties contributed to abrupt onset and recurrence.\"},{\"question\":\"How did clinicians attempt to manage the bleeding, and what was the outcome?\",\"answer\":\"Video-assisted thoracoscopic surgery was performed, but only palliative (R2) resection could be achieved. After postoperative day 9, a second massive hemothorax occurred, and although hematoma evacuation and pleurodeses were attempted, bleeding was not controlled and the patient died 30 days after symptom onset.\"}]","Hemothorax as the Initial Manifestation of KRAS G12D Positive Pulmonary Pleomorphic Carcinoma - A Case Report | PDF",1790707580]