A Rare Case of Pulmonary Sarcomatoid Carcinoma

Abstract

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].