Pulmonary carcinosarcoma is an unusual biphasic tumor of the lung with carcinomatous and sarcomatous components. We report a case in a 71-year-old female who presented with a 13-cm lung mass. Microscopic examination revealed squamous cell carcinoma and chondrosarcoma with focal spindle cell atypia. In the most recent version of the World Health Organization (WHO) classification, carcinosarcoma is included in the category of sarcomatous neoplasms with a poorer prognosis than non-small cell lung carcinoma.
A pulmonary carcinosarcoma (mixed malignant tumor) is an unusual malignant neoplasm of the lung that has poorly differentiated carcinoma and sarcomatous elements [1-2]. Carcinosarcomas are more frequently described in the uterus, esophagus, skin, lungs, and hypopharynx . Pulmonary carcinosarcoma accounts for 0.3% to 1% of all pulmonary neoplasms. It was first described by Kika et al. in 1908 [2-3]. Since the initial description by Kika, more cases have been published with different clinical and histological characteristics. Pulmonary carcinosarcomas are more common in men and strongly associated with smoking and asbestosis.
A 71-year-old nonsmoker female presented to the primary care physician with the chief complaints of difficulty in breathing, fatigue, and dry cough of eight to nine months duration. The patient had no significant past medical or surgical history. No known family history of cancer was present. She had a chest X-ray followed by computed tomography (CT), which showed a peripheral left lower lobe lung mass with mediastinal and hilar adenopathy. The patient underwent CT-guided lung biopsy of the lesion and an outside biopsy reported poorly differentiated carcinoma. The patient underwent the staging procedure with positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) brain, which revealed no evidence of metastatic disease, but a large fluorodeoxyglucose (FDG)-avid mass in the left lower lobe consistent with clinical T3No lung cancer. She was then referred to our hospital for further care.
The patient underwent left lower lobectomy and the staging procedure. The lobectomy specimen revealed a grey-white, well-circumscribed, firm mass measuring 13
In 2004, according to the World Health Organization (WHO) classification of lung tumors, sarcomatoid carcinomas
Carcinosarcoma of the lung can cause chest pain, breathing difficulties, fatigue, and other general signs and symptoms, such as fever, weight loss, and appetite loss. Our patient had clinical symptoms of breathing difficulty, fatigue, and dry cough. Radiographic findings comprise a solitary mass, as found in our case, or opacity leading to obstruction and associated
The gross features, such as color, size, and consistency, are nonspecific and differ. In a review of 30 cases of carcinosarcoma reported in the literature, all extra-bronchial masses were moderately firm, homogenous, and multinodular and the intrabronchial lesions were polypoid and soft [2-3].
Microscopically, the most common carcinomatous element is squamous cell carcinoma followed by adenocarcinoma and the most common sarcomatous element is the spindle cell elements or fibrosarcoma followed by chondrosarcoma, osteosarcoma, and rhabdomyosarcoma [4-5]. The sarcomatous component may predominate and obscure the carcinomatous component. Therefore, extensive sampling
The differential diagnoses are relatively few but, based on the predominant component and morphology, include other subtypes of sarcomatoid carcinoma, carcinoma with desmoplastic stroma, malignant mesothelioma, and metastatic sarcoma .
The prognosis of the endobronchial carcinosarcoma is more favorable than that for the peripheral carcinosarcoma, which leads to aggressive outcomes with early metastasis . Metastasis is common to the lymph node, followed by the brain, bone, kidney, and liver. Overall, there is a worse prognosis than for conventional non-small cell carcinoma due to the high tendency for distant metastasis, particularly when the sarcomatous component is predominant .
Pulmonary carcinosarcoma (PCS) is a rare biphasic lung tumor that presents either as a solid mass involving the peripheral lung parenchyma or a polypoid lesion involving the endobronchial tree. It is important to identify the epithelial and mesenchymal components to make the diagnosis. Histopathologic examination and immunohistochemical staining can help to distinguish it from other carcinomatous and sarcomatous neoplasms.
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- Sökücü SN, Kocatürk C, Ürer N, et al.: Evaluation of six patients with pulmonary carcinosarcoma with a literature review. Sci World J. 2012, 2012:167317. 10.1100%2F2012%2F167317
- Braham E, Rejeb HB, Aouadi S, Kilani T, El Mezni F: Pulmonary carcinosarcoma with heterologous component: report of two cases with literature review. Ann Transl Med. 2014, 2:41. 10.3978/j.issn.2305-5839.2014.02.10
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Pulmonary Carcinosarcoma: A Case Report of Biphasic Lung Tumor
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Cite this article as:
Devi P, Singh N, Tortora M J (September 13, 2019) Pulmonary Carcinosarcoma: A Case Report of Biphasic Lung Tumor. Cureus 11(9): e5643. doi:10.7759/cureus.5643
Received by Cureus: September 04, 2019
Peer review began: September 07, 2019
Peer review concluded: September 11, 2019
Published: September 13, 2019
© Copyright 2019
Devi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.