Sarcomatoid carcinoma is a rare histologic subtype of non-small cell lung cancer (NSCLC) that contains a component of sarcoma or sarcoma like elements(1) comprises less than 1 % of all lung cancers. CASE PRESENTATION: A 62-year-old woman with history of smoking presented to the emergency room for complaints of sharp sternal chest pain. On further inquiry, she complained of progressive dyspnea with a decline in her exercise tolerance. She also had a significant weightloss of 20-pound in the last 6 months. On examination, she was normotensive, afebrile. On auscultation, there were decreased breath sounds in the left upper lung with an increased expiratory phase.? CT of the chest revealed partial consolidation of the left upper lobe extending to the hilum with adjacent hilar and left mediastinal adenopathy. It also demonstrated several small nodular opacities within the right upper and middle lobes. A bronchoscopy was performed with brushing, endobronchial biopsy, and alveolar lavage of left upper lobe. Pathology showed poorly differentiated non-small cell carcinoma with giant cells and focal spindle cell features. DISCUSSION: Classification of these sarcomatoid carcinomas has been controversial due to variations in phenotype. As per the WHO classification of lung tumors, sarcomatoid carcinomas include pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma. (2)It usually presents as cough and hemoptysis in middle-aged men with history of smoking. The tumors are usually large, solitary upper lobes lesions. CONCLUSIONS: Sarcomatoid carcinomas can be difficult to identify and diagnose. There are no distinguishing radiologic features specific to these tumors and diagnosis cannot be made on the basis of cytology or small biopsy, however, features suggestive of the tumor in a small sampling may be mentioned on a descriptive basis, that is, poorly differentiated NSCLC with spindle and or giant cell carcinoma [2].

Nutcracker syndrome (NCS) (also known as Left renal vein (LRV) entrapment syndrome), is a rarely reported condition characterized by compression of the LRV leading to a clinical symptoms(1). Here we present a rare case of secondary membranous nephropathy (MN) with NCS. CASE PRESENTATION: A 47 year old male presented with complaints of generalized swelling associated with left flank pain and breathlessness for 2 weeks. Physical exam showed anasarca and varicocele. Laboratory results were significant for hypoalbuminemia (2.2 g/dL) and proteinuria (4.6 g/dL) suggestive of nephrotic syndrome. On chest x-ray, a left sided pleural effusion was noted which was transudative in nature on thoracentesis. Renal doppler ultrasound showed narrowed left renal vein with prominent collateral vessels. CT venography demonstrated a tiny caliber of the LRV secondary to stenosis at the level of the superior mesenteric artery and aorta suggestive of Nutcracker anatomy. Renal biopsy showed secondary MN, with negative PLAR-2 (phospholipase A2 receptor antibodies) staining with negative serum PLAR-2, indicating secondary MN. Malignant, infectious and autoimmune causes of secondary MN were ruled out. He was started on conservative management with lasix, losartan, atorvastatin and prednisone.

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