Sarcomatoid Carcinoma of the Lung – a Case Report

Abstract

Background: Sarcomatoid carcinoma (SARC) of the lung is a very rare and aggressive type of non-small cell lung cancer. It belongs to a group of poorly diff erentiated carcinomas with partial sarcomatoid diff erentiation or with a direct sarcoma component. Characteristic fi ndings include a large tumor with an invasive tendency, early recurrence and systemic metastases. Case: The authors present a case of SARC in the 77-year-old patient. Preoperative staging confi rmed sarcomatoid carcinoma of the lower lobe of the left lung without generalization on PET/ CT. However, an infi ltration of more than 2/ 3 of the diaphragm was ascertained. A resection was performed-a left lower lobectomy with resection of the diaphragm and its replacement by a muscle fl ap made from the latissimus dorsi muscle with vascular pedicle. Histological fi ndings confi rmed the dia gnosis of sarcomatoid (pleomorphic) carcinoma pT3N0M0. The patient underwent adjuvant chemotherapy; recurrence and systemic dissemination of the disease occurred after 20 months; the patient died 21 months after the surgery.

Primary Sarcomatoid Carcinoma of the Lung: Radiometabolic (18F-FDG PET/CT) Findings and Correlation with Clinico-Pathological and Survival Results

“…In this setting, the radiometabolic evaluation by 18 F-FDG PET/CT may represent a useful tool in the diagnostic work-up examination. Unfortunately, data provided by literature about metabolic evaluation in such tumours are very scarce, some consisting in case reports [7], sometimes mimicking non-neoplastic disease [8] or other malignances [9,10]. Despite its limitations, to the best of our best knowledge, this study is the first to focus on clinical value of PET/CT in a cohort of patients affected by this very rare subset of NSCLC.…”

“…Furthermore, several data exist on glucose metabolism assessed by 18 F-FDG PET and expressed as maximum standardized uptake values (SUVmax) as predictor of tumour characteristics and outcome in NSCLC cases [6]. Although 18 F-FDG PET/ CT findings are sporadically reported in the PSC surgical series available in the literature [7][8][9][10] specific analysis focused on radiometabolic evaluation and its prognostic impact in such rare neoplastic entity. Therefore, we collected a relative large cohort of PSC patients coming from 2 high-volume thoracic surgery centres to define the radiometabolic features of PSC by using 18 F-FDG PET/CT and explore the potential correlation of SUVmax with clinico-pathological characteristics and long-term survival results after surgery.…”

Sarcomatoid Carcinoma of the Lung Mimicking a Thromboembolic Disease

“…Adjuvant therapy is sometimes used but is poorly effective. 1,6 The prognosis is worse than the prognosis of other non-small cell lung carcinomas. 1 It essentially depends on the size and extent of the tumour.…”

“…It was recognised as a distinct entity by the World Health Organization classification (WHO 1999), updated in 2004 and 2015. 1 It is defined as a poorly differentiated non-small cell carcinoma that contains sarcomatous component or sarcoma-like elements.It represents an overall continuum of epithelial and mesenchymal differentiation 1,6. The diagnosis is based on the microscopic and the immunohistochemical examination.…”

“…The diagnosis is based on the microscopic and the immunohistochemical examination. Immunohistochemical analysis shows cytokeratin positivity (most often AE1AE3, CAM5.2, CK18, CK7).Vimentin, carcinoembryonic antigen (CEA) and smooth muscle markers can also be positive, but positivity of epithelial markers is not essential if components of conventional cancer are morphologically present 6.…”