Mixed malignant tumour of the lung.

Abstract

ABsTRAcr A mixed malignant tumour of the lung intermediate in type between pulmonary blastoma and carcinosarcoma is described. The epithelial component consisted of squamous carcinoma, undifferentiated carcinoma, and clefts lined by bland epithelial cells. The supporting stroma was composed of pleomorphic sarcoma, fibrosarcoma, chondrosarcoma, osteosarcoma, and indeterminate mesenchymal tissue. The tumour was removed surgically, but the patient died postoperatively with rapidly developing multiple bony and soft tissue metastases. Subcutaneous metastases showed the appearance of poorly differentiated pleomorphic sarcoma. Published reports of mixed malignant lung tumours are reviewed.Lung neoplasms that contain malignant connective tissue and epithelial elements may be classified into three subgroups-namely, carcinosarcomas, pulmonary blastomas, and "transitional" tumours (Davis et al, 1972). Carcinosarcomas are the least rare, and consist of islands of welldifferentiated squamous carcinoma or adenocarcinoma in a stroma of malignant spindle cells, which sometimes shows osseous or chondroid foci. They were first recognised in the early years of this century (Kika, 1908;Saltykow, 1914). Pulmonary blastomas (Spencer, 1961) or embryomas (Barnard, 1952) have a remarkable resemblance to fetal lung even at an ultrastructural level, with epithelial islands and tubules in a pleomorphic spindle cell stroma. The transitional variant, which shows the features of both blastoma and carcinosarcoma, was first described by Davis et al (1972). We describe a case of the latter type of tumour in which there was a wide spectrum of mesenchymal and epithelial malignancy. The pathology, histogenesis, and classification of mixed malignant pulmonary tumours is discussed, and the relevant published reports are reviewed. Case reportA 61-year-old confectioner presented in August 1977 with an eight-week history of non-productive cough, ankle swelling, and weight loss. He had had no serious illnesses in the past, and smoked two ounces (56 g) of pipe tobacco a week. He had mild ankle oedema and finger clubbing. A few crackles were heard at the left base. A chest radiograph showed a large, well-defined mass in the left lower zone and prominence of the left hilum Results of haematological and biochemical tests were normal. At bronchoscopy there was narrowing of the main lower lobe bronchus on the left side. A biopsy showed normal bronchial mucosa and cartilage.At thoracotomy four weeks later a mass was found occupying most of the left lower lobe. Lymph nodes at the hilum and in the pulmonary ligament were enlarged. A routine left pneumonectomy was carried out.Eight days after operation the patient began to complain of pain in the left thigh. A hard, tender, fusiform swelling was found in the quadriceps and a hard, rounded nodule over the lower end of the tibia. Over the next seven days several nodules appeared in the subcutaneous tissues of the lower legs and left upper chest. The nodules in the legs appeared to be fixed to underlying bone, and ra...

Gigant Carcinosarcoma

“…Classically, two forms of presentation have been distinguished: a central endobron chial variety with or without extension into the surround ing parenchyma, which appears as a peduncular mass and has a relatively better prognosis, later métastasés and ob structive pulmonary symptoms, and the peripheral variety, located in the pulmonary parenchyma which affects con tiguous structures (chest wall, mediastinum, diaphragm) with earlier métastasés, which implies a poorer prognosis [1,41. Some authors question the distinction made regard ing the prognosis [2,5].…”

Uncontrolled Growth of Tumour Stromal Fibroblasts in vitro

“…The significant role played by the connective tis sue has been stressed in morphological stud ies for several tumour types [2,9,18,26,28,32], It should also be mentioned here that in cases of complete tumour regression, con stantly accompanied by heavy lymphocytic infiltrate (tumour stromal reaction -immune surveillance) [17], tumour cells disintegrate and the tumour is eventually replaced by fibrous tissue [5,17], We believe that tumour stroma derived from mesenchymal tissues is influenced by adjacent neoplastic growth and/or by the im mune response of the organism to the neo plastic growth. The parallel increase of stro mal elements with that of tumour growth [32] should enhance the interest in the study of the relationship and interactions between malignant and non-malignant cells within a tumour.…”

“…Stromal fibroblasts interact with adjacent neoplastic cells in several types of tumours [2,9,18,26,28], The varying proportions and the morphological com plexity of the tumour stromal elements [10,32] point to the necessity of further investiga tion of the properties and the role of the stro mal cells in neoplasia. Although much re search in immune surveillance, as expressed by extensive lymphocytic infiltrate of the tu mour [17], has been performed, to our knowledge, the variety of the stromal ele ments of breast malignant and benign dis eases -including connective tissue, elastic tissue, inflammatory cells, and blood vessels [10, 12.…”

Biphasic Tumors of the Lung

“…72,77 Although it is easy to dismiss cases in which the "sarcomatous" component was that of the fibrosarcoma type, 78 cases in which the sarcomatous component is of the heterologous type, such as malignant bone, cartilage, or striated muscle, are more problematic. [79][80][81][82] Nevertheless, some investigators explain the presence of malignant bone, cartilage, or muscle as reflecting divergent differentiation "committed" to mesenchymal tissues and prefer to categorize these tumors as biphasic sarcomatoid carcinomas. 83 …”